{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"hclA aileCegavaS yme","gend":1,"add":"raG 8171dR nosir","city":"Cornelia","state":"GA","zip":305310000,"dob":"1989-05-17","age":"","mstatus":"","insh":"4687510081","cliId":"","pno":"6760783928","cno":"","email":"","ename":"","eno":"","pphy":"Thomas Hatchett","ppno":7067543997,"pcpadd":"870 AUSTIN DR STE A","pcpcity":"DEMOREST","pcpstate":"GA","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"On Exchange","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"1718 Garrison Rd","madd2":"","madd3":"","mcity":"Cornelia","mstate":"GA","mzip":30531,"pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.644","M18.11","R35.0","Z01.419","OOPDEDD","G56.03","R05.1","Z20.822","B00.9","R39.15","Z11.3","F31.5","F41.0","F60.5","F90.1","J06.9","G56.01"],"date":["2023-04-17","2023-04-17","2023-05-02","2023-05-02","2023-01-01","2023-02-16","2023-02-23","2023-02-23","2023-05-02","2023-05-02","2023-05-02","2023-02-15","2023-02-15","2023-02-15","2023-02-15","2023-02-23","2023-03-06"],"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":[["","","GABAPENTIN","100 MG CAPSULE","90","Select","Select",""],["","","ARIPIPRAZOLE","10 MG TABLET","30","Select","Select",""],["","","HYDROCODONE-HOMATROPINE SOLN","","120","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG DOSEPK","21","Select","Select",""],["","","ALPRAZOLAM","1 MG TABLET","90","Select","Select",""],["","","NAPROXEN","500 MG TABLET","60","Select","Select",""],["","","HYDROCODONE-ACETAMIN","5-325 MG","10","Select","Select",""],["","","PREDNISONE","20 MG TABLET","12","Select","Select",""],["","","VALACYCLOVIR HCL","500 MG TABLET","64","Select","Select",""],["","","METRONIDAZOLE","500 MG TABLET","14","Select","Select",""],["","","AZITHROMYCIN","250 MG TABLET","6","Select","Select",""],["","","ONDANSETRON ODT","4 MG TABLET","12","Select","Select",""],["","","ACYCLOVIR","5% OINTMENT","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":["",""],"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":""}]}]}