{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" C araSeocsirB","gend":1,"add":"iH S U 0262N 14 yawhg","city":"Fort Valley","state":"GA","zip":31030,"dob":"1958-12-23","age":"","mstatus":"","insh":"7736410081","cliId":"","pno":"5987430274","cno":"","email":"","ename":"","eno":"","pphy":"Jody Velie","ppno":"","pcpadd":"726 S 8th St","pcpcity":"Griffin","pcpstate":"GA","pcpzip":"","pcpcounty":"Griffin","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":["M86.172","E11.9","Z88.0","Z88.8","S91.301","E11.40","Z20.828","Z01.812","E03.4","F41.9","E53.8","I10","K21.9","E11.42","M13.0","M79.10","E55.9","Z01.818","Z01.810","L97.522","E03.9","E11.65","Z00.01","Z12.31","Z12.11","E66.9","S98.122","E11.43","E11.628","Z23","M25.551","M79.641","M25.531","M19.041","J01.90","M86.672","Z45.2","S91.302"],"date":["2021-10-13","2020-08-18","2020-08-18","2020-08-18","2021-10-26","2020-08-11","2020-08-11","2020-08-11","2021-10-06","2021-10-06","2021-12-28","2021-10-06","2021-12-28","2021-12-28","2021-10-06","2021-10-06","2021-12-28","2020-08-04","2020-08-04","2021-10-13","2020-11-17","2020-11-17","2021-06-08","2021-06-08","2021-06-08","2021-01-26","2020-09-29","2020-09-29","2020-09-29","2021-10-13","2021-01-26","2021-01-26","2021-02-11","2021-02-11","2021-06-29","2020-08-18","2020-08-04","2020-07-07"],"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":[["","50228018005","GABAPENTIN","300MGCAPSULE","120","Select","Select",""],["","69238183107","LEVOTHYROXINE","50MCGTABLET","30","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","68001025404","FLUCONAZOLE","200MGTABLET","7","Select","Select",""],["","169413212","OZEMPIC","0.25-0.5MG\/DOSEPEN","1.5","Select","Select",""],["","55111012705","CIPROFLOXACIN","HCL500MGTAB","20","Select","Select",""],["","24586903","TOUJEO","SOLOSTAR300UNIT\/ML","9","Select","Select",""],["","42858010250","OXYCODONE-ACETAMINOPHEN","5-325","28","Select","Select",""],["","43598021050","SSD","0.01CREAM","50","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","15","Select","Select",""],["","597015330","JARDIANCE","25MGTABLET","30","Select","Select",""],["","42806071405","BENZONATATE","100MGCAPSULE","15","Select","Select",""],["","68462039710","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","60505014201","GLIPIZIDE","10MGTABLET","45","Select","Select",""],["","68462018022","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","51224002218","AZITHROMYCIN","250MGTABLET","6","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":""}]}]}