{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MDE   CRAMSNAVE DNO","gend":0,"add":"NAC 801RD NON","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1970-01-20","age":"","mstatus":"","insh":"7200210*62","cliId":"","pno":"88\/7572734-0","cno":"757\/880-4372","email":"","ename":"","eno":"","pphy":"PRINGLE, ALANA D DO","ppno":"757\/877-0214","pcpadd":"13347 WARWICK BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23602,"pcpcounty":"","pcpid":157508,"pcpname":"DENBIGH FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N40.1","I89.8","C61.","Z51.0","R97.20","E55.9","M89.9","M16.12","G89.4","Z12.11","Z83.71","I10.","E78.5","Z79.899","Z00.00","R39.12","R39.14","C79.51","R59.9"],"date":["2020-07-07","2020-07-16","2021-11-08","2021-02-25","2020-07-07","2020-10-02","2021-01-04","2021-01-04","2020-10-02","2020-10-26","2020-10-26","2021-07-26","2021-07-26","2020-07-07","2021-07-26","2021-08-18","2021-08-18","2021-10-26","2021-10-26"],"priorHcc":["","",null,"","","","","","","","","","","","","","",null,null]}},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","10370010250","BUPROPN","300MG XL","30","Select","Select",""],["","70461031903","FLUCLVX","2019-20","0","Select","Select",""],["","65862008601","BISOPROL","5MG","30","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5MG","10","Select","Select",""],["","16729002310","BICALUTAMIDE","50MG","-30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","28","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","28","Select","Select",""],["","57237011490","ALFUZOSIN","10MG ER","-30","Select","Select",""],["","00469012599","XTANDI","40MG","-120","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","90","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59651017301","DOXEPIN","10MG","30","Select","Select",""],["","68180051201","LISINOPRIL","2.5MG","90","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","6","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","10370010250","BUPROPN ","300MG XL","30","Select","Select",""],["","70461031903","FLUCLVX ","2019-20","0","Select","Select",""],["","65862008601","BISOPROL ","5MG","-30","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","10","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","6","Select","Select",""],["","57237011490","ALFUZOSIN ","10MG ER","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","28","Select","Select",""],["","16729002310","BICALUTAMIDE ","50MG","30","Select","Select",""],["","59651017301","DOXEPIN ","10MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","14","Select","Select",""],["","00469012599","XTANDI ","40MG","120","Select","Select",""],["","57237001401","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","68180051201","LISINOPRIL ","2.5MG","90","Select","Select",""],["","13668001005","CITALOPRAM","20MG","90","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","90","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}