{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAMILLA M PREECE","gend":1,"add":"1240 Knightsbridge Ct Apt 205","city":"Charlottesville","state":"VA","zip":"22911-4651","dob":"1958-04-15","age":"","mstatus":"","insh":"11004314","cliId":"","pno":5402808614,"cno":5402922751,"email":"","ename":"","eno":"","pphy":"GUEDES DE MORAIS, AMANDA","ppno":"   ","pcpadd":"22 N Medical Park Dr","pcpcity":"Fishersville","pcpstate":"VA","pcpzip":229392344,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA HEALTH INTERNAL MEDICINE FISHERSVILLE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1240 Knightsbridge Ct Apt 205","madd2":"","madd3":"","mcity":"Charlottesville","mstate":"VA","mzip":"22911-4651","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":[["","00173069600","ADVAIR ","250\/50","60.00","Select","Select",""],["","68382005005","MELOXICAM ","7.5MG","30.00","Select","Select",""],["","50383077916","LACTULOSE ","10GM\/15","1,892.00","Select","Select",""],["","69097022416","ALENDRONATE ","70MG","4.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","180.00","Select","Select",""],["","43547035150","LISINOPRIL ","2.5MG","90.00","Select","Select",""],["","50742061510","METOPROL ","25MG ER","90.00","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","36.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","65862073260","AMIODARONE ","200MG","30.00","Select","Select",""],["","00487020103","IPRATROPIUM\/ ","ALBUTER","1,080.00","Select","Select",""],["","00054001829","PREDNISONE ","20MG","10.00","Select","Select",""],["","00173086910","ANORO ","62.5-25","60.00","Select","Select",""],["","49281041950","FLUZONE ","2019-20","0.50","Select","Select",""],["","69238199101","DIGOXIN ","0.125MG","30.00","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":""}]}]}