{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL J GIBSON","gend":0,"add":"PO BOX 171","city":"JONESVILLE","state":"VA","zip":"24263-0171","dob":"1955-10-21","age":"","mstatus":"","insh":"11015494","cliId":"","pno":2768321277,"cno":"","email":"","ename":"","eno":"","pphy":"ALMATARI, ABDULLATIEF","ppno":2765463001,"pcpadd":"127 Health Care Dr Ste 12","pcpcity":"Pennington Gap","pcpstate":"VA","pcpzip":242772853,"pcpcounty":"","pcpid":"","pcpname":"JONESVILLE FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 171","madd2":"","madd3":"","mcity":"JONESVILLE","mstate":"VA","mzip":"24263-0171","pcpfaxno":"(276) 546-9705","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":[["","65862057490","MONTELUKAST ","10MG","30.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","31722059690","FENOFIBRATE ","145MG","30.00","Select","Select",""],["","16729000517","SIMVASTATIN ","20MG","30.00","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","30.00","Select","Select",""],["","60505024708","MIRTAZAPINE ","15MG","30.00","Select","Select",""],["","00173086910","ANORO ","62.5-25","60.00","Select","Select",""],["","00143928501","AMOXICILLIN ","875MG","20.00","Select","Select",""],["","69315031228","PROCTO-MED ","HC 2.5%","56.00","Select","Select",""],["","45802000403","HYDROCORT ","2.50%","28.00","Select","Select",""],["","31722099701","HYDROCO\/APAP ","10-325MG","150.00","Select","Select",""],["","68645055154","LISINOPRIL ","5MG","90.00","Select","Select",""],["","65862069730","VENLAFAXINE ","150MG ER","30.00","Select","Select",""],["","00173068220","VENTOLIN ","","18.00","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":""}]}]}