{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Clint C Pottinger","gend":0,"add":"561 May White Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"1977-01-30","age":"","mstatus":"","insh":1056247003,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"JOHN COPE","ppno":"","pcpadd":"590 Historic Hwy 441N","pcpcity":"Demorest","pcpstate":"GA","pcpzip":"","pcpcounty":"Demorest","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K50.90","E78.49","R53.81","E55.9","Z79.899","F90.0","I10","Z68.29","R53.83","Z00.00","T78.2XX","L50.0","F17.200","T78.40X","M62.830","Z76.0","S60.561","J20.9","R05","Z20.828","F41.9","L40.59","R00.0","L40.0","R76.0","B35.6","D48.5","L30.9","K50.10"],"date":["2021-11-02","2021-06-01","2021-06-01","2021-06-01","2021-09-07","2021-08-24","2021-08-24","2021-08-24","2021-05-18","2021-05-18","2020-09-15","2020-09-15","2020-09-15","2020-07-28","2020-04-09","2020-08-11","2020-07-07","2021-07-20","2021-07-20","2021-07-20","2020-08-11","2021-09-14","2020-07-21","2021-09-14","2021-03-02","2021-04-20","2021-04-20","2021-04-27","2020-05-12"],"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":[]}]},{"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":[["","65862056099","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","57237001930","DULOXETINE","HCLDR60MGCAP","30","Select","Select",""],["","591565810","CYCLOBENZAPRINE","10MGTABLET","60","Select","Select",""],["","68180051703","LISINOPRIL","40MGTABLET","30","Select","Select",""],["","555097402","DEXTROAMP-AMPHETAMIN","30MGTAB","30","Select","Select",""],["","68462050201","AZATHIOPRINE","50MGTABLET","30","Select","Select",""],["","65162089129","MOMETASONE","FUROATE50MCGSPRY","17","Select","Select",""],["","50222030260","ENSTILAR","0.005%-0.064%FOAM","60","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","168000480","TRIAMCINOLONE","0.001CREAM","80","Select","Select",""],["","378064205","PREDNISONE","20MGTABLET","6","Select","Select",""],["","50474071079","CIMZIA","2X200MG\/MLSYRINGEKIT","2","Select","Select",""],["","93227534","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","45802070000","TACROLIMUS","0.001OINTMENT","90","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","603389032","HYDROCODONE-ACETAMIN","5-325MG","15","Select","Select",""],["","93598627","EPINEPHRINE","0.3MGAUTO-INJECT","2","Select","Select",""],["","591555305","DOXYCYCLINE","HYCLATE100MGTAB","20","Select","Select",""],["","52268020101","SUTAB","1.479-0.225-0.188GMTAB","24","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}