{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"yaW TREBORDRAWOH en","gend":0,"add":"AC 0456RD NONN","city":"FLOWERY BRANCH","state":"GA","zip":305420000,"dob":"1961-11-17","age":"","mstatus":"","insh":"3777410001","cliId":"","pno":"2507763397","cno":"","email":"","ename":"","eno":"","pphy":"ANDREW REISMAN","ppno":7705346053,"pcpadd":"4222 FAIRBANKS DR","pcpcity":"OAKWOOD","pcpstate":"GA","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"On Exchange","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"6450 CANNON DR","madd2":"","madd3":"","mcity":"FLOWERY BRANCH","mstate":"GA","mzip":30542,"pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47.12","H20.013","G89.29","I25.10","M47.22","M48.02","M50.13","M51.34","I12.9","E11.22","N18.9","Z95.5","M96.0","M50.03","M54.13","M50.120","H40.113","E11.9","H25.813","M43.22","M1A.00X","F41.9","E78.2","F98.8","I10","F33.1","N40.0","E53.8","R97.20","Z68.24","Z96.7","Z98.1","M51.36","M62.81","E29.1","H40.133","H40.41X","H02.403","H40.111","H91.90","Z86.73","Z96.82","M50.10"],"date":["2023-02-23","2023-02-23","2023-02-23","2023-06-06","2023-03-01","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-06-01","2023-03-21","2023-03-13","2023-05-30","2023-04-07","2023-03-29","2023-04-07","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2023-04-07","2023-04-07","2023-03-29","2023-03-01","2023-04-13","2023-04-27","2023-03-01","2023-04-07","2023-01-23","2023-03-09","2023-01-23","2023-03-21","2023-03-21","2023-03-21","2023-03-21","2023-02-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","","ESCITALOPRAM","20 MG TABLET","30","Select","Select",""],["","","ALPRAZOLAM","1 MG TABLET","90","Select","Select",""],["","","REPATHA","140 MG\/ML SURECLICK","2","Select","Select",""],["","","METOPROLOL TARTRATE","25 MG TAB","60","Select","Select",""],["","","VALACYCLOVIR HCL","500 MG TABLET","21","Select","Select",""],["","","ACETAZOLAMIDE ER","500 MG CAP","14","Select","Select",""],["","","ICOSAPENT ETHYL","1 GRAM CAPSULE","120","Select","Select",""],["","","ALLOPURINOL","300 MG TABLET","30","Select","Select",""],["","","BRIMONIDINE-TIMOLOL","0.2%-0.5%","5","Select","Select",""],["","","LATANOPROST","0.005% EYE DROPS","2.5","Select","Select",""],["","","METHOCARBAMOL","500 MG TABLET","60","Select","Select",""],["","","MUPIROCIN","2% OINTMENT","22","Select","Select",""],["","","DIFLUPREDNATE","0.05% EYE DROP","5","Select","Select",""],["","","EZETIMIBE","10 MG TABLET","30","Select","Select",""],["","","BRINZOLAMIDE","1% EYE DROPS","10","Select","Select",""],["","","FLOWFLEX COVID-","19 AG HOME TEST","4","Select","Select",""],["","","DEXTROAMP-AMPHETAMIN","30 MG TAB","60","Select","Select",""],["","","LOSARTAN POTASSIUM","100 MG TAB","30","Select","Select",""],["","","MELOXICAM","15 MG TABLET","30","Select","Select",""],["","","DICLOFENAC SODIUM","1% GEL","100","Select","Select",""],["","","PREDNISOLONE AC","1% EYE DROP","5","Select","Select",""],["","","LUMIGAN","0.01% EYE DROPS","2.5","Select","Select",""],["","","AMLODIPINE BESYLATE","5 MG TAB","30","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":""}]}]}