{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TINA R WHITE","gend":1,"add":"230 SUNSET AVENUE","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1963-04-09","age":"","mstatus":"","insh":"11004131","cliId":"","pno":8044845056,"cno":4349067168,"email":"","ename":"","eno":"","pphy":"GAZEWOOD, JOHN DAY","ppno":4349245348,"pcpadd":"1221 Lee Street 1st Floor","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229080001,"pcpcounty":"","pcpid":"","pcpname":"UVA PRIMARY CARE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"230 SUNSET AVENUE","madd2":"","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22903-9998","pcpfaxno":"(434) 924-8335","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":[["","62332000191","FAMOTIDINE ","20MG","30.00","Select","Select",""],["","60505267108","ATORVASTATIN ","80MG","90.00","Select","Select",""],["","68382012205","AMLODIPINE ","5MG","30.00","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","30.00","Select","Select",""],["","51672127401","BETAMETH ","0.05%","60.00","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12.00","Select","Select",""],["","31722070110","LOSARTAN ","50MG","30.00","Select","Select",""],["","68180035106","SERTRALINE ","25MG","30.00","Select","Select",""],["","53746051105","SPIRONOLACT ","25MG","90.00","Select","Select",""],["","68382011414","RISPERIDONE ","1MG","30.00","Select","Select",""],["","50111043303","TRAZODONE ","50MG","30.00","Select","Select",""],["","70461032103","FLUCLVX ","2021-22","0.50","Select","Select",""],["","55724021121","EUCRISA ","2%","60.00","Select","Select",""],["","00527260243","METOPROL ","100MG ER","60.00","Select","Select",""],["","00078077720","ENTRESTO ","49-51MG","60.00","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","60.00","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","15.00","Select","Select",""],["","16729001901","MYCOPHENOLAT ","500MG","120.00","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.50","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6.00","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00168000616","TRIAMCINOLON ","0.10%","80.00","Select","Select",""],["","68462024805","RANITIDINE ","150MG","60.00","Select","Select",""],["","68180095601","CLOBETASOL ","0.05%","30.00","Select","Select",""],["","00406055201","OXYCODONE ","5MG","12.00","Select","Select",""],["","00093026492","FLUOCINONIDE ","0.05%","60.00","Select","Select",""],["","00054001829","PREDNISONE ","20MG","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":["",""]}},{"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":""}]}]}