{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAH K FOLEY","gend":1,"add":"126 WILSON AVE","city":"GALAX","state":"VA","zip":"24333-9998","dob":"1960-02-28","age":"","mstatus":"","insh":"11017073","cliId":"","pno":2767793167,"cno":"","email":"","ename":"","eno":"","pphy":"FANT, VANESSA","ppno":8007657130,"pcpadd":"400 S Independence Ave","pcpcity":"Independence","pcpstate":"VA","pcpzip":243483972,"pcpcounty":"","pcpid":"","pcpname":"OLDTOWN MEDICAL CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"APT 12","add3":"","madd1":"126 WILSON AVE","madd2":"APT 12","madd3":"","mcity":"GALAX","mstate":"VA","mzip":"24333-9998","pcpfaxno":"(276) 238-8876","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":[["","70377003012","ATORVASTATIN ","80MG","30.00","Select","Select",""],["","38396031776","CVS ","33G","100.00","Select","Select",""],["","00093005805","TRAMADOL ","50MG","12.00","Select","Select",""],["","00006027731","JANUVIA ","100MG","30.00","Select","Select",""],["","70954006030","PREDNISONE ","20MG","15.00","Select","Select",""],["","51224002206","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","65862049501","QUETIAPINE ","400MG","30.00","Select","Select",""],["","42571025201","CLINDAMYCIN ","300MG","30.00","Select","Select",""],["","13107000305","MIRTAZAPINE ","30MG","30.00","Select","Select",""],["","00378932132","WIXELA ","250\/50","60.00","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","12.00","Select","Select",""],["","72578008801","NYSTAT\/TRIAM ","","15.00","Select","Select",""],["","00078077720","ENTRESTO ","49-51MG","60.00","Select","Select",""],["","00378668910","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","60.00","Select","Select",""],["","00173089310","TRELEGY ","ELLIPTA","60.00","Select","Select",""],["","67877056105","METFORMIN ","500MG","75.00","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","90.00","Select","Select",""],["","50742061510","METOPROL ","25MG ER","30.00","Select","Select",""],["","57237007530","ONDANSETRON ","4MG","15.00","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","20.00","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","60.00","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18.00","Select","Select",""],["","33342015611","CELECOXIB ","100MG","90.00","Select","Select",""],["","00310461612","BREZTRI ","SPHERE","10.70","Select","Select",""],["","00574010770","CLOTRIMAZOLE ","10MG","70.00","Select","Select",""],["","67405060203","FLUCONAZOLE ","100MG","2.00","Select","Select",""],["","68382066005","SPIRONOLACT ","25MG","30.00","Select","Select",""],["","21922000909","DICLOFENAC ","1%","100.00","Select","Select",""],["","49281040020","ADACEL ","","0.50","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0.50","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","120.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","31722094901","OXYCOD\/APAP ","5-325MG","16.00","Select","Select",""],["","00054032756","FLUTIC\/SALME ","250\/50","60.00","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21.00","Select","Select",""],["","33342002332","LEVOFLOXACIN ","750MG","5.00","Select","Select",""],["","55111012701","CIPROFLOXACN ","500MG","14.00","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":""}]}]}