{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ohT oJnosam","gend":1,"add":"lhaD 5895ywH ageno","city":"Clermont","state":"GA","zip":30527,"dob":"1960-04-22","age":"","mstatus":"","insh":"3882110095","cliId":"","pno":"6787607169","cno":"","email":"","ename":"","eno":"","pphy":"KATHRYN DUDAS","ppno":"","pcpadd":"1856 Thompson Bridge Road Ste 14","pcpcity":"Gainesville","pcpstate":"GA","pcpzip":"","pcpcounty":"Gainesville","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":["J96.11","K21.9","E11.9","E66.01","Z68.43","G47.30","R79.89","Z79.01","Z79.84","Z79.899","Z86.711","Z85.42","Z90.49","Z90.710","E03.9","I26.92","M54.2","M25.512","M79.89","Z20.822","E07.9","Z12.31","I27.82","R09.02","R07.89","R00.0","E03.8","Z13.220","Z00.00","Z23","G47.9","R79.1","R07.9","Z08","Z68.44","G47.33","J98.4","R06.09","R06.89","I31.9","D64.9","L03.115","R39.89","R06.02"],"date":["2020-03-12","2021-11-30","2021-12-07","2021-11-30","2021-12-07","2020-03-03","2020-04-09","2020-03-03","2021-12-07","2020-03-03","2021-12-07","2021-12-07","2020-03-03","2020-03-03","2021-11-30","2021-03-30","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-04-06","2021-12-16","2021-12-16","2021-04-20","2021-04-20","2020-04-09","2020-04-09","2020-04-09","2021-11-30","2021-11-30","2021-03-23","2021-03-23","2020-01-14","2020-03-03","2021-11-30","2021-11-30","2021-12-07","2021-12-07","2021-03-30","2021-03-30","2020-08-04","2020-03-03","2020-04-09"],"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":[["","76385012810","METFORMIN","HCLER500MGTABLET","90","Select","Select",""],["","3089421","ELIQUIS","5MGTABLET","60","Select","Select",""],["","169413212","OZEMPIC","0.25-0.5MGDOSEPEN","1.5","Select","Select",""],["","50111043301","TRAZODONE","50MGTABLET","30","Select","Select",""],["","59267100002","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","378181510","LEVOTHYROXINE","150MCGTABLET","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150MGTABLET","2","Select","Select",""],["","70461042010","FLUCELVAX","QUAD2020-2021VIAL","1","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","10","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":""}]}]}