{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MATTHEW T GLOVIER","gend":0,"add":"372 DUSF CIRCLE","city":"CASTLEWOOD","state":"VA","zip":"24224-9998","dob":"2000-04-28","age":"","mstatus":"","insh":"11014169","cliId":"","pno":2769716810,"cno":"","email":"","ename":"","eno":"","pphy":"WRIGHT, COLLEEN K","ppno":7037247530,"pcpadd":"44084 Riverside Pkwy Ste 300","pcpcity":"Leesburg","pcpstate":"VA","pcpzip":201765102,"pcpcounty":"","pcpid":"","pcpname":"LOUDOUN MEDICAL GROUP PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"372 DUSF CIRCLE","madd2":"","madd3":"","mcity":"CASTLEWOOD","mstate":"VA","mzip":"24224-9998","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":[["","13668022030","ARIPIPRAZOLE ","20MG","30.00","Select","Select",""],["","00054001925","PREDNISONE ","50MG","5.00","Select","Select",""],["","57237000830","MIRTAZAPINE ","15MG","30.00","Select","Select",""],["","50383017290","LEVOCARNITIN ","330MG","60.00","Select","Select",""],["","00143928501","AMOXICILLIN ","875MG","20.00","Select","Select",""],["","69238183607","LEVOTHYROXIN ","125MCG","60.00","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","210.00","Select","Select",""],["","69097086707","NADOLOL ","20MG","90.00","Select","Select",""],["","57237004705","DIVALPROEX ","250MG DR","360.00","Select","Select",""],["","51862094105","DIAZEPAM ","2MG","30.00","Select","Select",""],["","70710122501","AMITRIPTYLIN ","10MG","30.00","Select","Select",""],["","33332032101","AFLURIA ","2021-22","0.50","Select","Select",""],["","00591401201","VALPROIC ","250MG","120.00","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":""}]}]}