{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ocS divaDrevoD tt","gend":0,"add":"tA 3403rD snik","city":"Gainesville","state":"GA","zip":305070000,"dob":"1964-07-25","age":"","mstatus":"","insh":"5769410060","cliId":"","pno":"7307710914","cno":"","email":"","ename":"","eno":"","pphy":"J Henson","ppno":7702196000,"pcpadd":"1285 SIMS ST","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"On Exchange","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3043 Atkins Dr","madd2":"","madd3":"","mcity":"Gainesville","mstate":"GA","mzip":30507,"pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z47.89","M21.6X1","G47.33","M19.071","G89.18","G47.30","K21.9","I10","I48.91","F41.9","F32.A","E07.9","Z87.891","Z79.890","Z79.82","Z79.899","I48.0","Z68.34","M00.871","Z00.00","Z12.5","G62.9","Z11.4","F33.2","N40.0","L97.522","L97.529","M14.671","M00.9","F10.10","S93.04X"],"date":["2023-04-24","2023-03-31","2023-02-28","2023-06-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-02-06","2023-02-06","2023-03-20","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-04-11","2023-01-20","2023-01-06"],"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":[["","","AMLODIPINE BESYLATE","10 MG TAB","30","Select","Select",""],["","","TAMSULOSIN HCL","0.4 MG CAPSULE","30","Select","Select",""],["","","FENOFIBRATE","200 MG CAPSULE","30","Select","Select",""],["","","ROSUVASTATIN CALCIUM","20 MG TAB","30","Select","Select",""],["","","DUTASTERIDE","0.5 MG CAPSULE","30","Select","Select",""],["","","VRAYLAR","6 MG CAPSULE","30","Select","Select",""],["","","OMEPRAZOLE DR","20 MG CAPSULE","30","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","5-325","28","Select","Select",""],["","","LISINOPRIL","10 MG TABLET","30","Select","Select",""],["","","LEVOTHYROXINE","125 MCG TABLET","30","Select","Select",""],["","","CARVEDILOL","12.5 MG TABLET","60","Select","Select",""],["","","LOVASTATIN","40 MG TABLET","30","Select","Select",""],["","","EQ ASPIRIN EC","81 MG TABLET","30","Select","Select",""],["","","CHLORTHALIDONE","25 MG TABLET","15","Select","Select",""],["","","AMITRIPTYLINE HCL","150 MG TAB","30","Select","Select",""],["","","DULOXETINE HCL DR","60 MG CAP","30","Select","Select",""],["","","CEPHALEXIN","500 MG CAPSULE","20","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":""}]}]}