{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HENRY R KEMP","gend":0,"add":"170 BENTLEY HOLLOW RD","city":"PULASKI","state":"VA","zip":"24301-9998","dob":"1965-07-05","age":"","mstatus":"","insh":"11007687","cliId":"","pno":5409800132,"cno":"","email":"","ename":"","eno":"","pphy":"BROCHERO, ALFONSO D","ppno":5407693964,"pcpadd":"2900 LAMB CIRCLE","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":240736344,"pcpcounty":"","pcpid":"","pcpname":"PULASKI HEALTH AND REHAB CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"170 BENTLEY HOLLOW RD","madd2":"","madd3":"","mcity":"PULASKI","mstate":"VA","mzip":"24301-9998","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":[["","00228202996","ALPRAZOLAM ","0.5MG","60.00","Select","Select",""],["","17478071310","OFLOXACIN ","0.3% OP","5.00","Select","Select",""],["","70436001102","BUPROPN ","300MG XL","30.00","Select","Select",""],["","64380080308","RANITIDINE ","150MG","180.00","Select","Select",""],["","00065853302","CIPRODEX ","0.3-0.1%","7.50","Select","Select",""],["","00245003660","PREVALITE ","4GM PK","60.00","Select","Select",""],["","62332000231","FAMOTIDINE ","40MG","30.00","Select","Select",""],["","59746038506","TERAZOSIN ","5MG","90.00","Select","Select",""],["","69097012403","TOPIRAMATE ","100MG","60.00","Select","Select",""],["","62175041532","LANSOPRAZOLE ","15MG DR","30.00","Select","Select",""],["","49884046565","CHOLESTYRAM ","4GM","60.00","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","90.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","69238183201","LEVOTHYROXIN ","75MCG","90.00","Select","Select",""],["","70461042110","FLUCLVX ","2021-22","0.50","Select","Select",""],["","60758088005","FLUOROMETHOL ","0.1% OP","5.00","Select","Select",""],["","45802006405","TRIAMCINOLON ","0.10%","30.00","Select","Select",""],["","67877022210","GABAPENTIN ","100MG","180.00","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0.50","Select","Select",""],["","24208029505","TOBRA\/DEXAME ","0.3-0.1%","5.00","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":""}]}]}