{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"efinneJhcruB r","gend":1,"add":"revaeB 366dR EN elad","city":"Dalton","state":"GA","zip":30721,"dob":"1972-02-28","age":"","mstatus":"","insh":"035821002","cliId":"","pno":"1660718038","cno":"","email":"","ename":"","eno":"","pphy":"Timothy Snodgrass","ppno":"","pcpadd":"45 College Park Dr,Suite ","pcpcity":"Ringgold","pcpstate":"GA","pcpzip":"","pcpcounty":"Ringgold","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":["Z20.828","S69.91X","S19.9XX","M47.892","S09.90X","R73.09","R53.83","Z79.899","M25.50","E27.8","N95.9","N92.1","N95.1","J84.89","B97.29","M79.673","E78.00","R42","H69.93","J30.9","K21.9","G47.33","M79.643","R68.84","M89.9","Z88.5","Z88.2","Z88.1","Z91.041","Z88.8","E66.9","Z68.38","R00.1","J45.909","R07.9","D64.9","R23.2","R31.0","Z12.31","R94.31","R10.84","H30.032","H25.11","Z96.1","Z01.419","N93.8","U07.1","H20.012","G47.09","S09.8XX","S16.1XX","S60.221","V49.49X","H16.223","N92.4","D50.0","Z20.2","R93.89","N88.2","L25.9","M13.811","R51.9","M54.2","H93.11","R06.00","M25.511","M25.572","R91.8","S61.211","H20.13","J30.1","J30.2","T63.461","Z86.69","H93.13","J34.2","R00.2","I49.3","Z78.0"],"date":["2021-03-02","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-10-13","2021-10-13","2021-11-18","2021-10-13","2021-10-12","2020-02-04","2020-11-10","2020-11-10","2021-02-23","2021-02-23","2021-07-13","2021-07-13","2021-10-12","2021-03-23","2021-03-23","2021-02-02","2022-01-04","2020-10-20","2020-10-20","2020-10-20","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2021-11-09","2020-12-15","2020-12-29","2021-11-18","2021-11-18","2021-08-24","2021-06-01","2021-10-26","2021-10-13","2021-02-23","2021-02-23","2021-02-23","2021-06-01","2021-06-01","2021-01-06","2020-09-22","2020-03-12","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-02-09","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2021-06-15","2021-06-29","2021-02-11","2021-01-12","2021-02-11","2021-10-26","2021-07-27","2021-07-27","2020-12-29","2021-03-23","2021-03-23","2021-06-08","2021-06-08","2021-06-15","2020-12-08","2021-03-23","2021-03-23","2021-10-12","2021-10-12","2020-02-04"],"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":[["","65162089129","MOMETASONE","FUROATE50MCGSPRY","17","Select","Select",""],["","57237005920","CEFUROXIME","AXETIL500MGTAB","14","Select","Select",""],["","16714040604","LARIN","FE43831TABLET","28","Select","Select",""],["","10702000350","PROMETHAZINE","25MGTABLET","15","Select","Select",""],["","60758011905","PREDNISOLONE","AC0.01EYEDROP","5","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","62559049001","DIPHENOXYLATE-ATROP","2.5-0.025","30","Select","Select",""],["","69097014260","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","75826011510","PHENAZOPYRIDINE","200MGTAB","6","Select","Select",""],["","16714049602","CLOTRIMAZOLE-BETAMETHASONE","CRM","45","Select","Select",""],["","65853302","CIPRODEX","OTICSUSPENSION","7.5","Select","Select",""],["","168027740","CLINDAMYCIN","0.02VAGINALCREAM","40","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":""}]}]}