{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" yroKlefaT","gend":0,"add":"nesoR 913essartS ","city":"Helen","state":"GA","zip":30545,"dob":"1985-01-02","age":"","mstatus":"","insh":"0516310022","cliId":"","pno":"2687668762","cno":"","email":"","ename":"","eno":"","pphy":"Ayham Haddad","ppno":"","pcpadd":"4205 Mundy Mill Pl","pcpcity":"Oakwood","pcpstate":"GA","pcpzip":"","pcpcounty":"Oakwood","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":["F41.0","F34.1","G47.00","M54.10","E11.9","E78.5","E55.9","I16.9","M25.571","M79.604","I10","Z20.822","M79.10","R05.9","R53.83","J02.9","R26.89","S80.811","S80.812","S90.812","S82.244","Z68.33","R50.9","R40.236","R40.214","R40.225","F17.210","Z23","E29.1","R71.8","S82.241","F13.230","M79.661","S61.412","M62.838","S89.91X"],"date":["2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-09-02","2021-11-18","2020-05-12","2021-11-18","2021-10-20","2021-10-13","2021-10-20","2021-10-13","2021-10-13","2020-04-09","2020-05-12","2020-05-12","2020-05-12","2020-03-03","2020-03-03","2021-10-20","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-11-18","2021-11-18","2020-03-03","2020-03-10","2020-03-10","2021-01-19","2020-02-11","2020-06-09"],"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":[["","68462025401","ROPINIROLE","HCL0.5MGTABLET","15","Select","Select",""],["","228203150","ALPRAZOLAM","1MGTABLET","10","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","90","Select","Select",""],["","115166103","PROPRANOLOL","40MGTABLET","90","Select","Select",""],["","68180072103","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","52817018110","CLONIDINE","HCL0.2MGTABLET","30","Select","Select",""],["","42858010301","OXYCODON-ACETAMINOPHEN","7.5-325","30","Select","Select",""],["","68382075810","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","378395205","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","29300012510","MELOXICAM","15MGTABLET","30","Select","Select",""],["","54040013","DESVENLAFAXINE","SUCCNTER50MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","68382056601","METOPROLOL","SUCCER100MGTAB","30","Select","Select",""],["","68180037803","LOSARTAN","POTASSIUM100MGTAB","30","Select","Select",""],["","68382080601","TRAZODONE","100MGTABLET","30","Select","Select",""],["","143993905","AMOXICILLIN","500MGCAPSULE","30","Select","Select",""],["","42858010350","OXYCODONE-ACETAMINOPHN","7.5-325","60","Select","Select",""],["","62756001540","TESTOSTERONE","CYP200MG\/ML","2","Select","Select",""],["","169430313","RYBELSUS","3MGTABLET","30","Select","Select",""],["","59651036205","IBUPROFEN","800MGTABLET","30","Select","Select",""],["","68382091634","METHYLPREDNISOLONE","4MGDOSEPK","21","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}