{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YHTORODYELOF ","gend":1,"add":"tneC 231dR W yru","city":"Leesburg","state":"GA","zip":31763,"dob":"1966-12-01","age":"","mstatus":"","insh":"1794410033","cliId":"","pno":"9592229621","cno":"","email":"","ename":"","eno":"","pphy":"Shaun Cook","ppno":"","pcpadd":"807 S Isabella Street,N","pcpcity":"Sylvester","pcpstate":"GA","pcpzip":"","pcpcounty":"Sylvester","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"Lot 10A","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":["U07.1","R13.19","K44.9","K21.9","I10","M54.6","R13.10","Z79.899","E78.5","Z12.2","Z87.891","I25.10","Z76.0","Z95.5","R60.0","K21.00","K20.80","K22.10","Z20.822","G47.33","I11.0","I50.9","E03.9","I25.2","R73.09","Z20.828","I51.7","R05","M47.814","M54.5","Z68.37","E66.9","K62.5"],"date":["2021-12-08","2021-11-18","2021-11-23","2021-11-09","2021-09-14","2021-08-24","2021-11-09","2021-08-24","2021-11-23","2022-01-06","2021-11-09","2021-11-23","2021-07-13","2021-07-13","2021-07-13","2021-11-23","2021-11-09","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-10-06","2021-04-27","2021-11-09","2021-01-26","2021-09-01","2021-09-14","2021-09-14","2021-11-23","2021-09-28"],"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":[["","16714061205","SERTRALINE","HCL50MGTABLET","30","Select","Select",""],["","67877019905","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","16714085402","METOPROLOL","SUCCER100MGTAB","30","Select","Select",""],["","16729043316","EZETIMIBE","10MGTABLET","30","Select","Select",""],["","70377000913","ROSUVASTATIN","CALCIUM40MGTAB","30","Select","Select",""],["","55111018010","TIZANIDINE","HCL4MGTABLET","20","Select","Select",""],["","16714066202","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","68180097303","LEVOTHYROXINE","150MCGTABLET","30","Select","Select",""],["","832532510","POTASSIUM","CLER20MEQTABLET","30","Select","Select",""],["","68180052002","LISINOPRIL-HCTZ","20-25MGTAB","30","Select","Select",""],["","50111032703","HYDRALAZINE","25MGTABLET","60","Select","Select",""],["","591544310","PREDNISONE","20MGTABLET","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":""}]}]}