{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JORDAN I SINK","gend":0,"add":"99 PINE DALE DR","city":"ROCKY MOUNT","state":"VA","zip":"24151-9998","dob":"1999-06-22","age":"","mstatus":"","insh":"11015618","cliId":"","pno":2767347136,"cno":5404935676,"email":"","ename":"","eno":"","pphy":"BOHON, SONYA N","ppno":5404844800,"pcpadd":"390 S Main St Ste 101","pcpcity":"Rocky Mount","pcpstate":"VA","pcpzip":241511767,"pcpcounty":"","pcpid":"","pcpname":"CARILION FRANKLIN MEMORIAL HOSPITAL HOSPITALISTS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"99 PINE DALE DR","madd2":"","madd3":"","mcity":"ROCKY MOUNT","mstate":"VA","mzip":"24151-9998","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":[["","70710113803","FLUCONAZOLE ","100MG","7.00","Select","Select",""],["","00054016625","MYCOPHENOLAT ","500MG","60.00","Select","Select",""],["","00121087316","LACTULOSE ","10GM\/15","473.00","Select","Select",""],["","61874011530","VRAYLAR ","1.5MG","30.00","Select","Select",""],["","50742061610","METOPROL ","50MG ER","90.00","Select","Select",""],["","55111029336","SUMATRIPTAN ","100MG","9.00","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90.00","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","90.00","Select","Select",""],["","60505393001","GUANFACINE ","4MG ER","30.00","Select","Select",""],["","43598075201","BUPROPION ","150MG SR","60.00","Select","Select",""],["","00228212750","CLONIDINE ","0.1MG","90.00","Select","Select",""],["","43547030703","ARIPIPRAZOLE ","30MG","30.00","Select","Select",""],["","45802005611","GENTAMICIN ","0.10%","30.00","Select","Select",""],["","14539067501","HYDROXYZ ","50MG","30.00","Select","Select",""],["","68382039801","POT  CHLORIDE","20MEQ ER","60.00","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","90.00","Select","Select",""],["","68180071160","CEFDINIR ","300MG","3.00","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","270.00","Select","Select",""],["","68180065208","DOXYCYC ","100MG","30.00","Select","Select",""],["","00378064010","PREDNISONE ","5MG","30.00","Select","Select",""],["","70710120901","ALLOPURINOL ","100MG","90.00","Select","Select",""],["","00574222545","TRETINOIN ","0.03%","45.00","Select","Select",""],["","65862050220","AMOX\/K ","500-125","10.00","Select","Select",""],["","00093770198","LEVOCETIRIZI ","5MG","90.00","Select","Select",""],["","65862039110","ONDANSETRON ","8MG ODT","12.00","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","28.00","Select","Select",""],["","70436001102","BUPROPN ","300MG XL","30.00","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","2.00","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","60.00","Select","Select",""],["","59148001013","ABILIFY ","20MG","30.00","Select","Select",""],["","55111012850","CIPROFLOXACN ","750MG","2.00","Select","Select",""],["","55111053201","DIVALPROEX ","125MG","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":""}]}]}