{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANCIS A STAPLETON","gend":1,"add":"266 MCGEE LN","city":"GATE CITY","state":"VA","zip":"24251-9998","dob":"1990-12-12","age":"","mstatus":"","insh":"11004704","cliId":"","pno":4237325396,"cno":"","email":"","ename":"","eno":"","pphy":"MICHAEL, GARY E","ppno":4232459600,"pcpadd":"17285 Veterans Memorial Hwy","pcpcity":"Dungannon","pcpstate":"VA","pcpzip":242453937,"pcpcounty":"","pcpid":"","pcpname":"CLINCH RIVER HEALTH SERVICES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"266 MCGEE LN","madd2":"","madd3":"","mcity":"GATE CITY","mstate":"VA","mzip":"24251-9998","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":[["","70954002010","PRAZOSIN ","2MG","30.00","Select","Select",""],["","16714062101","ZOLPIDEM ","5MG","30.00","Select","Select",""],["","70010049105","METFORMIN ","ORAL TAB","30.00","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","90.00","Select","Select",""],["","16714074804","OMEPRAZOLE ","40MG","30.00","Select","Select",""],["","69315013801","BENZTROPINE ","2MG","30.00","Select","Select",""],["","00603548421","PROPRANOLOL ","40MG","30.00","Select","Select",""],["","00093100301","BUSPIRONE ","15MG","90.00","Select","Select",""],["","13107003134","MIRTAZAPINE ","15MG","30.00","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","60.00","Select","Select",""],["","16714008310","HYDROXYZ ","50MG","60.00","Select","Select",""],["","31722054501","LITHIUM ","300MG","120.00","Select","Select",""],["","13107015690","PAROXETINE ","30MG","60.00","Select","Select",""],["","70069038301","HALOPER ","100MG\/ML","2.00","Select","Select",""],["","69097084607","CYCLOBENZAPR ","10MG","30.00","Select","Select",""],["","64764080530","ROZEREM ","8MG","30.00","Select","Select",""],["","68462024805","RANITIDINE ","150MG","28.00","Select","Select",""],["","16714081901","OSELTAMIVIR ","75MG","10.00","Select","Select",""],["","00378033401","HALOPERIDOL ","10MG","14.00","Select","Select",""],["","65757030001","VIVITROL ","380MG","1.00","Select","Select",""],["","13668042990","PANTOPRAZOLE ","40MG","14.00","Select","Select",""],["","65862069730","VENLAFAXINE ","150MG ER","30.00","Select","Select",""],["","43598021040","SSD ","1%","400.00","Select","Select",""],["","21922000909","DICLOFENAC ","1%","100.00","Select","Select",""],["","55111053401","DIVALPROEX ","500MG ER","270.00","Select","Select",""],["","57237023301","SMZ-TMP ","800-160","20.00","Select","Select",""],["","50458030611","RISPERDAL ","25MG","2.00","Select","Select",""],["","45802013970","METRONIDAZOL ","0.75%VAG","70.00","Select","Select",""],["","00548570100","MEDROXYPR ","150MG\/ML","1.00","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","15.00","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","13668021830","ARIPIPRAZOLE ","10MG","30.00","Select","Select",""],["","59148001971","ABILIFY ","400MG","1.00","Select","Select",""],["","68382080705","TRAZODONE ","150MG","14.00","Select","Select",""],["","00591024105","LORAZEPAM ","1MG","28.00","Select","Select",""],["","65862001305","SERTRALINE ","100MG","30.00","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","21.00","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","20.00","Select","Select",""],["","00603533832","PREDNISONE ","10MG","14.00","Select","Select",""],["","57664050658","METOPROL ","25MG","30.00","Select","Select",""],["","16714069101","FLUCONAZOLE ","100MG","2.00","Select","Select",""],["","53746010905","HYDROCO\/APAP ","5-325MG","12.00","Select","Select",""],["","61314063006","NEO\/POLY\/DEX ","0.1% OP","5.00","Select","Select",""],["","66685100100","AMOX\/K ","875-125","20.00","Select","Select",""],["","31722070010","LOSARTAN ","25MG","90.00","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","69238110002","DOXYCYCL ","100MG","20.00","Select","Select",""],["","00487950160","ALBUTEROL ","0.08%","180.00","Select","Select",""],["","45802005911","NYSTATIN ","100000","30.00","Select","Select",""],["","42858010301","OXYCOD\/APAP ","7.5-325","12.00","Select","Select",""],["","63304069205","CLINDAMYCIN ","150MG","21.00","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}