{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERTA L TOLBERT","gend":1,"add":"4313 GARST MILL RD","city":"ROANOKE","state":"VA","zip":"24018-9998","dob":"1969-06-22","age":"","mstatus":"","insh":"11015222","cliId":"","pno":5404920377,"cno":"","email":"","ename":"","eno":"","pphy":"ARTHUR, CHRISTY L","ppno":5407257800,"pcpadd":"3707 Brambleton Ave Ste 2","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240183658,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE BRAMBLETON","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APT G","add3":"","madd1":"4313 GARST MILL RD","madd2":"APT G","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24018-9998","pcpfaxno":"(540) 989-6752","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":[["","65862016001","ZOLPIDEM ","10MG","7.00","Select","Select",""],["","16729013716","CLONAZEPAM ","1MG","14.00","Select","Select",""],["","00456111030","VIIBRYD ","10MG","5.00","Select","Select",""],["","65162010150","GABAPENTIN ","100MG","120.00","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","1.50","Select","Select",""],["","00093100301","BUSPIRONE ","15MG","90.00","Select","Select",""],["","64764072030","TRINTELLIX ","5MG","30.00","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","300.00","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","60.00","Select","Select",""],["","65862069790","VENLAFAXINE ","150MG ER","30.00","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","LITE","1.00","Select","Select",""],["","00781569031","EZETIMIBE ","10MG","90.00","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0.50","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2.00","Select","Select",""],["","00406055201","OXYCODONE ","5MG","10.00","Select","Select",""],["","58160081912","SHINGRIX ","50\/0.5ML","1.00","Select","Select",""],["","68382000514","TOPIRAMATE ","25MG","60.00","Select","Select",""],["","70954003620","CLOTRIMAZOLE ","1%","30.00","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15.00","Select","Select",""],["","00088221905","LANTUS ","100\/ML","3.00","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","60.00","Select","Select",""],["","58160084252","BOOSTRIX ","","0.50","Select","Select",""],["","70954005930","PREDNISONE ","10MG","21.00","Select","Select",""],["","58160088752","FLUARIX ","2021-22","0.50","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","20.00","Select","Select",""],["","43547035311","LISINOPRIL ","10MG","90.00","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","6.00","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","30.00","Select","Select",""],["","00406012405","HYDROCO\/APAP ","7.5-325","20.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}