{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OWEN W WILLIAMS JR","gend":0,"add":"386 GRANDVIEW DRIVE","city":"AMHERST","state":"VA","zip":"24521-3124","dob":"1963-04-20","age":"","mstatus":"","insh":"11014618","cliId":"","pno":4344204821,"cno":"","email":"","ename":"","eno":"","pphy":"GUANZON, VERNA","ppno":4349739744,"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":"175 CRESTWOOD DRIVE","add3":"","madd1":"386 GRANDVIEW DRIVE","madd2":"175 CRESTWOOD DRIVE","madd3":"","mcity":"AMHERST","mstate":"VA","mzip":"24521-3124","pcpfaxno":"(434) 846-2655","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":[["","31722052590","FINASTERIDE ","5MG","30.00","Select","Select",""],["","55111012205","ATORVASTATIN ","20MG","18.00","Select","Select",""],["","60505311308","OLANZAPINE ","10MG","30.00","Select","Select",""],["","68180044501","QUETIAPINE ","25MG","60.00","Select","Select",""],["","00378181177","LEVOTHYROXIN ","112MCG","30.00","Select","Select",""],["","00904640180","TAMSULOSIN ","0.4MG","30.00","Select","Select",""],["","00591024110","LORAZEPAM ","1MG","60.00","Select","Select",""],["","65649000330","TRULANCE ","3MG","30.00","Select","Select",""],["","43386033001","TRIMETHOPRIM ","100MG","30.00","Select","Select",""],["","65862000601","CITALOPRAM ","20MG","15.00","Select","Select",""],["","63304062210","ATENOLOL ","50MG","30.00","Select","Select",""],["","65862056099","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","28.00","Select","Select",""],["","57664023288","NITROFUR ","50MG","30.00","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14.00","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":["",""]}},{"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":""}]}]}