{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA LAMBERT","gend":1,"add":"2074 Goat Neck Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"1958-11-13","age":"","mstatus":"","insh":1061638001,"cliId":"","pno":6788865169,"cno":"","email":"dl556@yahoo.com","ename":"","eno":"","pphy":"Wylie Newton","ppno":"","pcpadd":"2578 Helen Hwy","pcpcity":"Cleveland","pcpstate":"GA","pcpzip":"","pcpcounty":"Cleveland","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":["R73.01","I10","E78.2","E74.39","K21.9","U07.1","R82.998","M81.0","J30.9","Z12.31","Z12.11","R69","Z12.12","M79.641","M70.62","M25.512","M25.552","Z68.29","E21.3","E04.1","R53.83","D48.5","E78.5","Z00.00","Z13.820","Z20.828","J02.9","Z01.411","N95.2","Z68.30","S16.1XX","S39.012","Z20.822","J06.9","R03.0","Z78.0","J01.90","R09.81","R42","R51.9","L57.0","D18.01","L81.4","L82.1","Z28.89","M62.81","M79.89","M25.50","M79.642","R63.8","Z68.31","S29.019","V89.2XX","Z23","Z48.02","D22.5"],"date":["2021-02-16","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-02-23","2021-02-23","2021-08-24","2021-02-23","2021-04-27","2021-05-18","2021-08-24","2021-02-23","2021-12-16","2021-12-21","2021-12-21","2021-09-21","2021-10-26","2021-02-16","2021-02-16","2021-02-16","2021-06-15","2020-11-10","2021-02-23","2020-11-10","2020-08-11","2020-08-11","2021-06-01","2021-06-01","2022-01-04","2021-06-22","2021-07-06","2022-01-04","2022-01-04","2022-01-04","2020-05-12","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-09-14","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-12-21","2021-07-06","2021-07-06","2020-02-11","2021-06-22","2021-06-15"],"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":[["","43547040211","FUROSEMIDE","40MGTABLET","30","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","68645056854","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","62037056005","POTASSIUM","CLER10MEQCAPSULE","30","Select","Select",""],["","29300022019","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","68645055254","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","29300013501","CLONIDINE","HCL0.1MGTABLET","30","Select","Select",""],["","406012301","HYDROCODONE-ACETAMIN","5-325MG","12","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","143928501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","67877021660","CEFUROXIME","AXETIL500MGTAB","20","Select","Select",""],["","55513071001","PROLIA","60MG\/MLSYRINGE","1","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.2","Select","Select",""],["","58160082311","SHINGRIX","VIALKIT","1","Select","Select",""],["","57237007710","ONDANSETRON","ODT4MGTABLET","15","Select","Select",""],["","93354143","ESTRADIOL","0.0001CREAM","42.5","Select","Select",""],["","55111018015","TIZANIDINE","HCL4MGTABLET","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":["",""]}},{"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":""}]}]}