{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTAL L WELCHER","gend":1,"add":"101 HOUNDS CHASE LANE SW APT 3","city":"ROANOKE","state":"VA","zip":"24014-9998","dob":"1974-02-23","age":"","mstatus":"","insh":"11014889","cliId":"","pno":5403131315,"cno":"","email":"","ename":"","eno":"","pphy":"LANTZ, JERI LYNN","ppno":5409858100,"pcpadd":"1030 S Jefferson St Ste 106","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240164418,"pcpcounty":"","pcpid":"","pcpname":"HURT PARK TEEN HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"101 HOUNDS CHASE LANE SW APT 3","madd2":"","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24014-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65162052110","PROMETHAZINE ","25MG","60.00","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","65862067899","ALPRAZOLAM ","1MG","60.00","Select","Select",""],["","64764017530","DEXILANT ","60MG DR","90.00","Select","Select",""],["","33342002208","LEVOFLOXACIN ","500MG","7.00","Select","Select",""],["","00093005805","TRAMADOL ","50MG","60.00","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","120.00","Select","Select",""],["","45802014167","CICLOPIROX ","8%","6.60","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18.00","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","90.00","Select","Select",""],["","70710160901","BACLOFEN ","5MG","30.00","Select","Select",""],["","50111043301","TRAZODONE ","50MG","30.00","Select","Select",""],["","71093014005","METHOCARBAM ","500MG","60.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","00093914801","VENLAFAXINE ","37.5MG","30.00","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","60.00","Select","Select",""],["","69097012203","TOPIRAMATE ","25MG","360.00","Select","Select",""],["","51991074790","DULOXETINE ","30MG","90.00","Select","Select",""],["","13107015490","PAROXETINE ","10MG","30.00","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}