{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"yentruoCseliM D ","gend":1,"add":"luoB 766rD drave","city":"Thomson","state":"GA","zip":30824,"dob":"1985-05-08","age":"","mstatus":"","insh":"7233410096","cliId":"","pno":"3707442866","cno":"","email":"","ename":"","eno":"","pphy":"DARYL WILEY","ppno":"","pcpadd":"315 Fluker St","pcpcity":"Thomson","pcpstate":"GA","pcpzip":"","pcpcounty":"Thomson","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"Apt 2","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":["Z00.00","Z68.44","E11.65","E11.69","E78.5","R00.2","I10","E11.9","E66.9","Z68.42","Z87.891","Z79.4","Z79.899","R06.00","J30.9","E66.01","E23.0","Z23","F32.1","Z91.14","R60.0","K21.9","K05.00","R00.0","R10.12","S39.91X","R07.81","G89.11","F41.9","F32.A","Z80.3","R07.89","R06.09","E78.2","Y09","I49.3","I49.1","K08.89"],"date":["2021-05-25","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-05-25","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-30","2021-11-18","2021-02-11","2021-05-25","2021-05-25","2021-05-25","2021-11-30","2021-11-30","2021-11-30","2021-08-24","2021-05-25","2021-11-30","2021-11-30","2021-07-27","2021-07-27","2021-09-07","2021-09-07","2021-11-18","2021-11-18","2021-11-18","2021-04-13","2021-04-13","2021-02-11","2021-07-20","2021-04-13","2021-04-13","2021-11-23"],"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":[["","93914801","VENLAFAXINE","HCL37.5MGTABLET","60","Select","Select",""],["","50742061510","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","93505898","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","49483060250","IBUPROFEN","400MGTABLET","30","Select","Select",""],["","116200116","CHLORHEXIDINE","0.0012RINSE","473","Select","Select",""],["","70436001002","BUPROPION","HCLXL150MGTABLET","30","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","7","Select","Select",""],["","68382075810","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","68180051201","LISINOPRIL","2.5MGTABLET","30","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","16","Select","Select",""],["","2879959","HUMALOG","100UNIT\/MLKWIKPEN","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":""}]}]}