{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAINT P MOSS","gend":0,"add":"127 BRIDGE LANE","city":"APPOMATTOX","state":"VA","zip":"24522-9998","dob":"1958-06-10","age":"","mstatus":"","insh":"11013019","cliId":"","pno":4346095525,"cno":"","email":"","ename":"","eno":"","pphy":"WRIGHT, RONNA K","ppno":4345822273,"pcpadd":"131 Jones St","pcpcity":"Appomattox","pcpstate":"VA","pcpzip":245229830,"pcpcounty":"","pcpid":"","pcpname":"PRIVIA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 944","madd2":"","madd3":"","mcity":"APPOMATTOX","mstate":"VA","mzip":"24522-9998","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":[["","70069000701","OLOPATADINE ","0.10%","5.00","Select","Select",""],["","63304082705","ATORVASTATIN ","10MG","30.00","Select","Select",""],["","65862014501","CARVEDILOL ","25MG","120.00","Select","Select",""],["","50228017905","GABAPENTIN ","100MG","90.00","Select","Select",""],["","45802006436","TRIAMCINOLON ","0.10%","80.00","Select","Select",""],["","69315011805","FUROSEMIDE ","80MG","90.00","Select","Select",""],["","64980043501","MIDODRINE ","10MG","60.00","Select","Select",""],["","10702018901","HYDROCO\/APAP ","5-325MG","90.00","Select","Select",""],["","29033002602","CALC ","667MG","400.00","Select","Select",""],["","62332019030","FEBUXOSTAT ","40MG","30.00","Select","Select",""],["","33342006015","CLOPIDOGREL ","75MG","30.00","Select","Select",""],["","57237010199","METOPROL ","50MG","90.00","Select","Select",""],["","55111078927","SEVELAMER ","800MG","270.00","Select","Select",""],["","67877048330","TELMISARTAN ","40MG","30.00","Select","Select",""],["","00310110530","LOKELMA ","5GM","30.00","Select","Select",""],["","67877019810","AMLODIPINE ","5MG","30.00","Select","Select",""],["","43547039950","CYCLOBENZAPR ","5MG","21.00","Select","Select",""],["","43547039711","HYDROCHLOROT ","25MG","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":[]}]},{"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":""}]}]}