{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNA C OSBORNE","gend":1,"add":"507 BROWN ST","city":"MARION","state":"VA","zip":"24354-9998","dob":"1953-08-03","age":"","mstatus":"","insh":"11008539","cliId":"","pno":2767067733,"cno":"","email":"","ename":"","eno":"","pphy":"CLAMPITT, ROBERT V","ppno":2767837167,"pcpadd":"1020 Terrace Dr Ste 100","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544392,"pcpcounty":"","pcpid":"","pcpname":"FAMILY PHYSICIANS OF MARION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"507 BROWN ST","madd2":"","madd3":"","mcity":"MARION","mstate":"VA","mzip":"24354-9998","pcpfaxno":"(276) 783-6432","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":[["","13668001005","CITALOPRAM ","20MG","90.00","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473.00","Select","Select",""],["","00173085910","BREO ","100-25","60.00","Select","Select",""],["","00115166103","PROPRANOLOL ","40MG","180.00","Select","Select",""],["","31722053101","TORSEMIDE ","20MG","60.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60.00","Select","Select",""],["","53746054201","POT  CHLORIDE","10MEQ ER","180.00","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","180.00","Select","Select",""],["","70377000415","SIMVASTATIN ","40MG","90.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","90.00","Select","Select",""],["","00378064110","PREDNISONE ","10MG","39.00","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20.00","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","20.00","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","42.00","Select","Select",""],["","57664051083","MIRTAZAPINE ","7.5MG","90.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28.00","Select","Select",""],["","68180051201","LISINOPRIL ","2.5MG","90.00","Select","Select",""],["","00023916360","RESTASIS ","0.05%","180.00","Select","Select",""],["","68180045901","AMLOD\/BENAZP ","5-20MG","90.00","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","90.00","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30.00","Select","Select",""],["","57664037713","TRAMADOL ","50MG","28.00","Select","Select",""],["","65162075310","BENAZEPRIL ","20MG","90.00","Select","Select",""],["","68180071160","CEFDINIR ","300MG","20.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","49884093547","DICLOFENAC ","1%","1,500.00","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90.00","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","10.00","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90.00","Select","Select",""],["","66689000816","NYSTATIN ","100000","480.00","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":""}]}]}