{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE L DECARLO","gend":1,"add":"163 TIDE PARKS TRAIL","city":"PENNINGTON GAP","state":"VA","zip":"24277-9998","dob":"1977-07-22","age":"","mstatus":"","insh":"11016770","cliId":"","pno":2765460129,"cno":2766395612,"email":"","ename":"","eno":"","pphy":"DEEL, SAMUEL P","ppno":2766799100,"pcpadd":"310 3rd St NE","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731137,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"163 TIDE PARKS TRAIL","madd2":"","madd3":"","mcity":"PENNINGTON GAP","mstate":"VA","mzip":"24277-9998","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":[["","57237010099","METOPROL ","25MG","90.00","Select","Select",""],["","69238131409","PREGABALIN ","150MG","60.00","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","90.00","Select","Select",""],["","00173088210","BREO ","200-25","60.00","Select","Select",""],["","00406996101","TEMAZEPAM ","15MG","30.00","Select","Select",""],["","59310057922","PROAIR ","","25.50","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90.00","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","60.00","Select","Select",""],["","29300013901","DIVALPROEX ","250MG DR","360.00","Select","Select",""],["","72305010030","EUTHYROX ","100MCG","90.00","Select","Select",""],["","00093505898","ATORVASTATIN ","40MG","90.00","Select","Select",""],["","42858000301","OXYCODONE ","15MG","90.00","Select","Select",""],["","47781065190","LEVOTHYROXIN ","100MCG","90.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","13107008305","LORAZEPAM ","0.5MG","4.00","Select","Select",""],["","46287000601","SPS ","15GM\/60","300.00","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354.00","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6.00","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":""}]}]}