{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ZINA R GARRETT","gend":1,"add":"103 SANDY LANE","city":"APPOMATTOX","state":"VA","zip":"24522-9250","dob":"1966-03-04","age":"","mstatus":"","insh":"11015001","cliId":"","pno":4346647973,"cno":"","email":"","ename":"","eno":"","pphy":"BROSE, TEODORA G","ppno":4343528235,"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":"103 SANDY LANE","madd2":"","madd3":"","mcity":"APPOMATTOX","mstate":"VA","mzip":"24522-9250","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":[["","42858010250","OXYCOD\/APAP ","5-325MG","28.00","Select","Select",""],["","70954002010","PRAZOSIN ","2MG","60.00","Select","Select",""],["","68001041504","DULOXETINE ","60MG","60.00","Select","Select",""],["","00591321901","BUT\/ASA\/CAFF ","","30.00","Select","Select",""],["","68001024617","ONDANSETRON ","4MG ODT","12.00","Select","Select",""],["","60505257808","ATORVASTATIN ","10MG","90.00","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","100.00","Select","Select",""],["","29300011316","LAMOTRIGINE ","150MG","180.00","Select","Select",""],["","68382080505","TRAZODONE ","50MG","30.00","Select","Select",""],["","94046000173","PEN  NEEDLES  ","31GX8MM","100.00","Select","Select",""],["","00456120230","LINZESS ","290MCG","90.00","Select","Select",""],["","55513084301","AIMOVIG ","140MG\/ML","1.00","Select","Select",""],["","00456111030","VIIBRYD ","10MG","30.00","Select","Select",""],["","69918030130","TRANEX ","650MG","3.00","Select","Select",""],["","16729044316","BUPROPN ","150MG XL","30.00","Select","Select",""],["","68382014005","TOPIRAMATE ","100MG","90.00","Select","Select",""],["","67877024210","QUETIAPINE ","25MG","60.00","Select","Select",""],["","68001028108","DICLOFENAC ","75MG DR","60.00","Select","Select",""],["","00406012510","HYDROCO\/APAP ","10-325MG","20.00","Select","Select",""],["","68180018001","CEFADROXIL ","500MG","14.00","Select","Select",""],["","00378034501","DIAZEPAM ","5MG","30.00","Select","Select",""],["","69547035302","NARCAN ","","2.00","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":""}]}]}