{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MATTHEW C GAMMON","gend":0,"add":"1010 DALE STREET","city":"STAUNTON","state":"VA","zip":"24401-2043","dob":"1996-06-16","age":"","mstatus":"","insh":"11006887","cliId":"","pno":5402519646,"cno":8044772032,"email":"","ename":"","eno":"","pphy":"SALOMON, ALEXANDER","ppno":5402132630,"pcpadd":"1800 Timberwood Blvd Ste A","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229117544,"pcpcounty":"","pcpid":"","pcpname":"UVA PRIMARY AND SPECIALITY CARE ZIONS CROSS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"1010 DALE ST","add3":"","madd1":"1010 DALE STREET","madd2":"1010 DALE ST","madd3":"","mcity":"STAUNTON","mstate":"VA","mzip":"24401-2043","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":[["","00527150537","AMPHET\/DEXTR ","20MG","90.00","Select","Select",""],["","69097083512","SERTRALINE ","100MG","30.00","Select","Select",""],["","60505283503","ATOMOXETINE ","80MG","30.00","Select","Select",""],["","43547034206","RISPERIDONE ","2MG","30.00","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","60.00","Select","Select",""],["","65162019050","NAPROXEN ","500MG","30.00","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20.00","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","20.00","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","6.00","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":""}]}]}