{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"pS nasuSnnamlle","gend":1,"add":"kraP 0406evA dneB ","city":"Braselton","state":"GA","zip":305170000,"dob":"1967-07-17","age":"","mstatus":"","insh":"2702220056","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"MARISSA MERCADO","ppno":7066582452,"pcpadd":"26 W JACKSON COMMONS DR","pcpcity":"HOSCHTON","pcpstate":"GA","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"On Exchange","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"6040 Park Bend Ave","madd2":"","madd3":"","mcity":"Braselton","mstate":"GA","mzip":30517,"pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M05.89","Z79.899","Z79.1","M85.9","H52.03","H10.45","H02.88A","H02.88B","H01.001","H01.004","H57.89","M06.9","Z68.1","L24.9","H20.013","F41.1","R51.9","R42","I11.9"],"date":["2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-01-10","2023-01-17","2023-04-28","2023-04-28","2023-04-28","2023-04-28","2023-02-28","2023-02-28","2023-03-30","2023-03-29","2023-01-17","2023-02-14","2023-03-30","2023-03-30","2023-03-30"],"priorHcc":["","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","","LISINOPRIL","20 MG TABLET","30","Select","Select",""],["","","HYDROXYCHLOROQUINE","200 MG TAB","45","Select","Select",""],["","","TACROLIMUS","0.03% OINTMENT","30","Select","Select",""],["","","ENBREL","50 MG\/ML SURECLICK","4","Select","Select",""],["","","PREDNISONE","20 MG TABLET","5","Select","Select",""],["","","DESONIDE","0.05% CREAM","15","Select","Select",""],["","","PREDNISOLONE AC","1% EYE DROP","10","Select","Select",""],["","","ERYTHROMYCIN","0.5% EYE OINTMENT","3.5","Select","Select",""],["","","BUSPIRONE HCL","5 MG TABLET","60","Select","Select",""],["","","TOBRAMYCIN-DEXAMETH OPHTH SUSP","","5","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG TABLET","21","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}