{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUNE A STUMP","gend":1,"add":"3203 GARDEN CITY BLVD SOUTH EAST","city":"ROANOKE","state":"VA","zip":"24014-9998","dob":"1942-04-03","age":"","mstatus":"","insh":"11016515","cliId":"","pno":5409153589,"cno":"","email":"","ename":"","eno":"","pphy":"DEBELAK, JACOB P","ppno":5409818574,"pcpadd":"1906 Belleview Ave SE","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240141838,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3203 GARDEN CITY BLVD SOUTH EAST","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":[["","59762040105","SUCRALFATE ","1GM","120.00","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","6.00","Select","Select",""],["","69097083512","SERTRALINE ","100MG","30.00","Select","Select",""],["","00469260130","MYRBETRIQ ","25MG","30.00","Select","Select",""],["","68462019790","PRAVASTATIN ","40MG","180.00","Select","Select",""],["","00143992701","CIPROFLOXACN ","250MG","6.00","Select","Select",""],["","00527169501","BUT\/APAP\/CAF ","","21.00","Select","Select",""],["","31722053301","METHOCARBAM ","500MG","40.00","Select","Select",""],["","13668010501","ISOSORB ","60MG ER","30.00","Select","Select",""],["","16729022501","SPIRONOLACT ","25MG","30.00","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","30.00","Select","Select",""],["","65862006399","METOPROL ","50MG","180.00","Select","Select",""],["","68645053254","LISINOPRIL ","20MG","180.00","Select","Select",""],["","55111019630","CLOPIDOGREL ","75MG","90.00","Select","Select",""],["","68180069706","TRAMADOL ","100MG ER","60.00","Select","Select",""],["","68645035159","CARVEDILOL ","12.5MG","60.00","Select","Select",""],["","51991074790","DULOXETINE ","30MG","90.00","Select","Select",""],["","65862042001","SMZ\/TMP ","800-160","28.00","Select","Select",""],["","00172208380","HYDROCHLOROT ","25MG","90.00","Select","Select",""],["","65862060330","MOXIFLOXACIN ","400MG","10.00","Select","Select",""],["","68382013814","TOPIRAMATE ","25MG","60.00","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","1% OTIC","10.00","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25.00","Select","Select",""],["","57237007530","ONDANSETRON ","4MG","60.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30.00","Select","Select",""],["","00054023525","MORPHINE ","15MG","84.00","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90.00","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","20.00","Select","Select",""],["","00143211250","DOXYCYCL ","100MG","60.00","Select","Select",""],["","16571066001","MECLIZINE ","12.5MG","120.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","43598051030","ESOMEPRA ","40MG DR","90.00","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","4.00","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":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}