{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ENELRADSEHGUH ","gend":1,"add":"aM 5012dR nah","city":"Summerville","state":"GA","zip":30747,"dob":"1958-08-05","age":"","mstatus":"","insh":"1967120004","cliId":"","pno":"5860722147","cno":"","email":"","ename":"","eno":"","pphy":"WAYNE RICHEY","ppno":"","pcpadd":"11 Charley Harper Drive,Suite 10","pcpcity":"Cartersville","pcpstate":"GA","pcpzip":"","pcpcounty":"Cartersville","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":["I10","E78.5","K21.9","D50.9","R74.8","R94.39","E55.9","Z20.822","E66.9","Z68.31","Z79.82","Z79.01","R54","F41.9","Z95.1","Z86.711","Z86.718","Z85.118","Z85.038","Z85.43","Z85.42","Z92.21","M62.81","R26.2","C54.1","R30.9","R07.89","R06.00","R11.0","Z86.16","C18.2","K66.0","R60.1","J90","C18.8","Z20.828","I95.9","M79.641","N20.1","N20.0","Z43.2","R07.9","C78.01","M62.549","K90.9","M79.642","M62.838","R53.83","M60.89","K12.0","Z90.710","M47.14","R10.9","Z90.49","G89.18","M06.4","J98.4","R91.8","R73.9","E78.00","Z53.8","Z86.2","R07.2","R06.02","A41.9","M47.12","K52.9","R53.1","J44.9","J98.9","Z51.11","M50.30","R69","I20.8","J94.8","R76.8","Z79.899","K25.3","R91.1","R10.11","M54.5","M62.830","I82.509","I82.409","I26.99","N30.00","C78.00","M15.0","M51.04","G31.9","R90.82","J01.00","Z12.31","D64.89","J02.9"],"date":["2021-05-25","2021-07-20","2021-07-20","2021-04-27","2021-04-27","2021-04-27","2021-05-25","2021-06-15","2021-04-27","2021-04-27","2021-04-27","2021-06-01","2021-04-27","2021-05-25","2021-04-27","2021-07-20","2021-12-08","2021-04-27","2021-06-01","2021-04-27","2021-12-28","2021-04-27","2022-01-04","2022-01-04","2021-12-08","2021-12-08","2021-08-05","2021-11-16","2021-12-08","2021-07-20","2021-12-08","2021-11-23","2021-12-08","2021-12-08","2021-12-08","2020-11-10","2020-11-10","2021-12-28","2020-07-21","2021-06-22","2021-11-23","2021-04-06","2021-12-08","2021-12-08","2021-11-02","2021-12-28","2021-08-10","2022-01-04","2021-12-28","2021-12-08","2021-06-01","2021-12-28","2021-08-24","2020-10-13","2020-10-13","2021-12-28","2021-05-25","2021-08-17","2021-12-28","2021-06-01","2021-06-01","2021-06-01","2021-02-23","2021-08-24","2021-08-24","2021-11-09","2020-03-17","2021-12-28","2021-06-15","2021-06-15","2020-04-09","2021-10-06","2021-08-10","2021-02-23","2021-05-25","2021-07-06","2021-07-06","2021-08-10","2021-08-10","2021-08-10","2021-05-04","2021-05-04","2021-05-04","2020-07-28","2020-07-28","2020-02-25","2021-10-12","2021-12-28","2021-12-28","2021-10-20","2021-10-20","2021-12-28","2020-08-11","2020-06-23","2021-06-15"],"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":[["","59746017509","PREDNISONE","20MGTABLET","7","Select","Select",""],["","16714047802","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","50383028604","LEVOFLOXACIN","25MG\/MLSOLUTION","200","Select","Select",""],["","406055201","OXYCODONE","HCL5MGTABLET","60","Select","Select",""],["","16714008403","SPIRONOLACTONE","25MGTABLET","30","Select","Select",""],["","68382013210","TAMSULOSIN","HCL0.4MGCAPSULE","21","Select","Select",""],["","65862018830","ONDANSETRON","HCL8MGTABLET","24","Select","Select",""],["","29033000305","SUCRALFATE","1GMTABLET","60","Select","Select",""],["","50458058030","XARELTO","10MGTABLET","30","Select","Select",""],["","406012310","HYDROCODONE-ACETAMIN","5-325MG","20","Select","Select",""],["","143988901","AMOXICILLIN","250MG\/5MLSUSP","400","Select","Select",""],["","16714039302","CEFDINIR","250MG\/5MLSUSP","100","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","7","Select","Select",""],["","65862018601","CLINDAMYCIN","HCL300MGCAPSULE","20","Select","Select",""],["","16714087603","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","62011001902","HM","ASPIRINEC81MGTABLET","30","Select","Select",""],["","65649040001","PLENVU","POWDERPACKETS","3","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","378020810","FUROSEMIDE","20MGTABLET","14","Select","Select",""],["","55111018010","TIZANIDINE","HCL4MGTABLET","30","Select","Select",""],["","527128201","DICYCLOMINE","20MGTABLET","30","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","20","Select","Select",""],["","52817033200","CYCLOBENZAPRINE","10MGTABLET","21","Select","Select",""],["","121086816","NYSTATIN","100000UNIT\/MLSUSP","240","Select","Select",""],["","16714043901","NITROFURANTOIN","MONO-MCR100MG","14","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":""}]}]}