{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"rehpotsirhCleinaDcM L ","gend":0,"add":" eunevA 091skaO eht fo","city":"Rock Springs","state":"GA","zip":30739,"dob":"1965-02-04","age":"","mstatus":"","insh":"0001MA100762","cliId":"","pno":"9532456153","cno":"","email":"","ename":"","eno":"","pphy":"ERIC BETTS","ppno":"","pcpadd":"12978 N Main St","pcpcity":"Trenton","pcpstate":"GA","pcpzip":"","pcpcounty":"Trenton","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","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":["G47.33","G47.14","I48.91","I44.4","J98.4","I48.0","I42.0","E66.01","R20.2","Z79.899","M99.01","M99.02","M99.03","M99.04","M99.05","M25.521","M54.5","M54.16","R51","R07.9","G43.909","M62.838","M54.9","G47.01","G47.61","E66.09","K57.30","M70.62","M76.12","Z20.828","I25.10","K21.9","J45.909","M19.90","I50.9","R79.89","E66.9","Z68.38","Z79.01","Z98.890","I77.819","I48.19","K44.9","F41.9","I77.810","Z20.822","J32.9","R06.2","R09.81","M62.830","G47.00","B00.1","M25.552","B35.6","G89.29","L30.9","I71.2","Z12.11","E78.2","I10","E78.5","R94.31","I51.89","I51.7","J01.90","J20.9","R07.2","J84.10"],"date":["2021-03-23","2021-03-23","2021-03-23","2020-07-21","2020-07-21","2021-02-02","2021-03-16","2021-07-27","2021-02-11","2021-02-11","2021-12-14","2021-12-14","2021-12-14","2021-11-02","2021-11-02","2021-11-02","2020-03-31","2020-03-31","2020-09-22","2020-09-22","2021-02-02","2020-09-22","2020-09-29","2020-07-28","2020-07-28","2020-07-28","2020-09-22","2021-08-03","2021-08-03","2020-11-17","2021-12-14","2021-07-20","2020-09-01","2020-02-11","2020-02-11","2020-02-04","2020-02-11","2020-02-11","2020-08-25","2020-08-25","2020-12-15","2021-07-27","2020-09-01","2021-01-26","2021-12-21","2021-03-16","2021-03-16","2021-03-16","2020-11-17","2020-06-09","2021-07-20","2021-01-26","2021-07-20","2021-07-20","2020-09-29","2020-09-29","2021-04-06","2020-09-01","2021-07-27","2021-07-27","2021-04-06","2020-01-14","2020-01-14","2020-01-14","2021-09-02","2021-09-02","2020-12-15","2020-09-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","45963070911","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","16729013716","CLONAZEPAM","1MGTABLET","30","Select","Select",""],["","55566670001","CLENPIQ","SOLUTION","320","Select","Select",""],["","68382079201","ACYCLOVIR","800MGTABLET","90","Select","Select",""],["","13668010401","ISOSORBIDE","MONONITER30MGTB","90","Select","Select",""],["","55111012305","ATORVASTATIN","40MGTABLET","90","Select","Select",""],["","68180072003","AMLODIPINE","BESYLATE5MGTAB","90","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4MGTABLETSL","25","Select","Select",""],["","378668977","PANTOPRAZOLE","SODDR40MGTAB","90","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","69097014260","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","42806071501","BENZONATATE","200MGCAPSULE","30","Select","Select",""],["","52817033200","CYCLOBENZAPRINE","10MGTABLET","90","Select","Select",""],["","70954005930","PREDNISONE","10MGTABDOSEPACK","21","Select","Select",""],["","33342008845","RIZATRIPTAN","10MGTABLET","9","Select","Select",""],["","781185220","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","65862001705","AMOXICILLIN","500MGCAPSULE","15","Select","Select",""],["","781569031","EZETIMIBE","10MGTABLET","90","Select","Select",""],["","68382050010","OMEPRAZOLE","DR40MGCAPSULE","90","Select","Select",""],["","50458057930","XARELTO","20MGTABLET","90","Select","Select",""],["","406012405","HYDROCODONE-ACETAMIN","7.5-325","7","Select","Select",""],["","51672130803","CLOTRIMAZOLE-BETAMETHASONE","LOT","30","Select","Select",""],["","57237000630","FLUCONAZOLE","200MGTABLET","3","Select","Select",""],["","65862017760","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","378932032","WIXELA","100-50INHUB","60","Select","Select",""],["","52817032110","BACLOFEN","20MGTABLET","21","Select","Select",""],["","23650110","UBRELVY","100MGTABLET","10","Select","Select",""],["","64380080707","IBUPROFEN","800MGTABLET","15","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":""}]}]}