{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L miKihtu","gend":1,"add":"loB 5383dR gnid","city":"Flowery Branch","state":"GA","zip":305420000,"dob":"1965-12-02","age":"","mstatus":"","insh":"8625410062","cliId":"","pno":"6807797411","cno":"","email":"","ename":"","eno":"","pphy":"JACK CHENG","ppno":7708489130,"pcpadd":"4754 MARTIN RD","pcpcity":"FLOWERY BRANCH","pcpstate":"GA","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"On Exchange","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3835 Bolding Rd","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":["M54.59","M51.37","M41.26","Z20.822","J02.9","J06.9","K21.9","R10.13","R13.10","J45.21"],"date":["2023-04-21","2023-04-21","2023-04-21","2023-05-10","2023-05-10","2023-05-10","2023-04-13","2023-04-13","2023-04-13","2023-03-01"],"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","5 MG TABLET","30","Select","Select",""],["","","ONDANSETRON ODT","4 MG TABLET","24","Select","Select",""],["","","PROMETHAZINE-DM","6.25-15 MG\/5ML","120","Select","Select",""],["","","ADVAIR HFA","115-21 MCG INHALER","12","Select","Select",""],["","","VENLAFAXINE HCL ER","37.5 MG CAP","30","Select","Select",""],["","","SERTRALINE HCL","50 MG TABLET","30","Select","Select",""],["","","ALENDRONATE SODIUM","70 MG TAB","4","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG DOSEPK","21","Select","Select",""],["","","FAMOTIDINE","40 MG TABLET","60","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG CP","30","Select","Select",""],["","","ZOLPIDEM TARTRATE","10 MG TABLET","30","Select","Select",""],["","","MONTELUKAST SOD","10 MG TABLET","30","Select","Select",""],["","","PANTOPRAZOLE SOD DR","40 MG TAB","30","Select","Select",""],["","","BENZONATATE","200 MG CAPSULE","42","Select","Select",""],["","","SUCRALFATE","1 GM TABLET","120","Select","Select",""],["","","AZITHROMYCIN","250 MG TABLET","6","Select","Select",""],["","","IPRAT-ALBUT","0.5-3(2.5) MG\/3 ML","360","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG CAP","20","Select","Select",""],["","","ALBUTEROL HFA","90 MCG INHALER","8.5","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":""}]}]}