{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER B MENDEZ-GONZALEZ","gend":0,"add":"1500CARLTON AVENUE","city":"CHARLOTTESVILLE               ","state":"VA","zip":"22902-5884","dob":"2005-07-03","age":"","mstatus":"","insh":4312169,"cliId":"","pno":4348256744,"cno":"","email":"","ename":"","eno":"","pphy":"MALEK, AMY","ppno":4342969161,"pcpadd":"1011 E JEFFERSON ST,","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":"22902-5354","pcpcounty":"","pcpid":"","pcpname":"PEDIATRIC ASSOCIATES OF CHARLOTTESVILLE PLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"1500CARLTON AVENUE","add3":"","madd1":"1500CARLTON AVENUE","madd2":"TRLR 34                                                     ","madd3":"","mcity":"CHARLOTTESVILLE               ","mstate":"VA","mzip":"22902-5884","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":[]},{"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":[]},{"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":["",""],"sub":{}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{}}},{"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":""}]}]}