{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARIE H HALL","gend":1,"add":"15927 RUFFIN LN","city":"AMELIA COURT HOUSE","state":"VA","zip":"23002-9998","dob":"1960-07-14","age":"","mstatus":"","insh":"11000166","cliId":"","pno":8048366015,"cno":"","email":"","ename":"","eno":"","pphy":"PAINE, MATTHEW S","ppno":8047396142,"pcpadd":"13540 Hull Street Rd","pcpcity":"Midlothian","pcpstate":"VA","pcpzip":231122107,"pcpcounty":"","pcpid":"","pcpname":"ST FRANCIS FAMILY MEDICINE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"15927 RUFFIN LN","madd2":"","madd3":"","mcity":"AMELIA COURT HOUSE","mstate":"VA","mzip":"23002-9998","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":[["","31722072250","LEVOFLOXACIN ","500MG","7.00","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","180.00","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","90.00","Select","Select",""],["","00023650110","UBRELVY ","100MG","10.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","17.00","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30.00","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","60.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","10702005601","OXYCODONE ","10MG","60.00","Select","Select",""],["","00069046956","CHANTIX ","1MG","60.00","Select","Select",""],["","42799012001","BUMETANIDE ","1MG","60.00","Select","Select",""],["","59762045001","COLESTIPOL ","1GM","60.00","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","60505265401","TRAZODONE ","100MG","90.00","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","90.00","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","10.00","Select","Select",""],["","00023916360","RESTASIS ","0.05%","60.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","70.00","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","90.00","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","28.00","Select","Select",""],["","69238137403","TOBRA\/DEXAME ","0.3-0.1%","5.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","Select","Select",""],["","00245021211","MIDODRINE ","5MG","90.00","Select","Select",""],["","65162062711","TRAMADOL ","50MG","15.00","Select","Select",""],["","68382013905","TOPIRAMATE ","50MG","90.00","Select","Select",""],["","65862052830","VENLAFAXINE ","75MG ER","30.00","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100.00","Select","Select",""],["","50458057830","XARELTO ","15MG","10.00","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","30.00","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","15.00","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","30.00","Select","Select",""],["","00093031901","DILTIAZEM ","60MG","90.00","Select","Select",""],["","00527169505","BUT\/APAP\/CAF ","","30.00","Select","Select",""],["","59746012106","MECLIZINE ","25MG","30.00","Select","Select",""],["","72618300002","NURTEC ","75MG ODT","8.00","Select","Select",""],["","58160081912","SHINGRIX ","50\/0.5ML","1.00","Select","Select",""],["","51672400501","CARBAMAZEPIN ","200MG","30.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","49884012201","LABETALOL ","100MG","180.00","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":""}]}]}