{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"yrogerGnottuD ","gend":0,"add":"niH 661dR ES e","city":"Rome","state":"GA","zip":301610000,"dob":"1971-03-09","age":"","mstatus":"","insh":"7209130056","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"JOHN-SCOTT CARROLL","ppno":7065095000,"pcpadd":"1825 MARTHA BERRY BLVD NW","pcpcity":"ROME","pcpstate":"GA","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"On Exchange","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"166 Hine SE Rd","madd2":"","madd3":"","mcity":"Rome","mstate":"GA","mzip":30161,"pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S83.221","M22.41","M79.644","D18.01","L57.0","M79.641","M25.641","M25.441","M86.8X4","M72.2","C06.0","H90.3","H93.13","H61.23","S83.271","M25.561","M25.562","K21.9","I10","M86.149","N52.39"],"date":["2023-01-20","2023-01-20","2023-01-10","2023-05-22","2023-05-22","2023-01-10","2023-01-10","2023-01-10","2023-01-10","2023-01-12","2023-02-07","2023-02-07","2023-02-07","2023-02-07","2023-01-20","2023-04-26","2023-04-26","2023-03-28","2023-03-28","2023-03-28","2023-03-28"],"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":[["","","TRAZODONE","50 MG TABLET","30","Select","Select",""],["","","ESOMEPRAZOLE MAG DR","40 MG CAP","30","Select","Select",""],["","","MELOXICAM","15 MG TABLET","30","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG TAB","30","Select","Select",""],["","","NIFEDIPINE ER","60 MG TABLET","30","Select","Select",""],["","","PREDNISONE","10 MG TABLET","7","Select","Select",""],["","","IBUPROFEN","800 MG TABLET","30","Select","Select",""],["","","HYDROCODONE-ACETAMIN","10-325 MG","28","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":""}]}]}