{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GERALDINE JENKINS","gend":1,"add":"115 TOMS LANE","city":"ROSELAND","state":"VA","zip":"22967-9998","dob":"1940-04-18","age":"","mstatus":"","insh":"11015253","cliId":"","pno":4342775980,"cno":"","email":"","ename":"","eno":"","pphy":"COURTNEY, ANDREA U","ppno":5406723010,"pcpadd":"4916 Plank Rd Unit 205","pcpcity":"North Garden","pcpstate":"VA","pcpzip":229591613,"pcpcounty":"","pcpid":"","pcpname":"UVA STONEY CREEK FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"115 TOMS LANE","madd2":"","madd3":"","mcity":"ROSELAND","mstate":"VA","mzip":"22967-9998","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":[["","57237000830","MIRTAZAPINE ","15MG","66.00","Select","Select",""],["","00003089421","ELIQUIS ","5MG","132.00","Select","Select",""],["","10370083211","DILTIAZEM ","300MG ER","90.00","Select","Select",""],["","16729022501","SPIRONOLACT ","25MG","55.00","Select","Select",""],["","50111091703","TORSEMIDE ","20MG","62.00","Select","Select",""],["","16729014501","QUETIAPINE ","25MG","24.00","Select","Select",""],["","31722070210","LOSARTAN ","100MG","90.00","Select","Select",""],["","27241000306","RISPERIDONE ","0.5MG","90.00","Select","Select",""],["","00065924007","DUREZOL ","0.05%","5.00","Select","Select",""],["","65862001105","SERTRALINE ","25MG","73.00","Select","Select",""],["","21922000909","DICLOFENAC ","1%","300.00","Select","Select",""],["","68382022714","AMIODARONE ","200MG","90.00","Select","Select",""],["","00121089316","CHLORHEX ","0.12%","473.00","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20.00","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":""}]}]}