{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Danny Waters","gend":0,"add":"165 Lonesome Pine Trl","city":"Alto","state":"GA","zip":30510,"dob":"1973-04-05","age":"","mstatus":"","insh":1212355001,"cliId":"","pno":7069498780,"cno":"","email":"amanda.waters197740@gmail.com","ename":"","eno":"","pphy":"Nima Ghasemzadeh","ppno":"","pcpadd":"1400 River Pl","pcpcity":"Braselton","pcpstate":"GA","pcpzip":"","pcpcounty":"Braselton","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":["I11.9","R94.31","Z68.20","N20.0","F17.210","Z01.818","M51.37","K63.89","N32.89","F17.200","R10.9","R11.0","R42","Z72.0","Z68.21","M54.17","K52.9","R10.32","M48.061","M51.26","M47.816","M51.36","M48.07","M47.817"],"date":["2021-08-31","2021-03-23","2021-06-29","2021-08-31","2021-08-31","2021-03-23","2021-03-16","2021-06-22","2021-06-22","2021-06-29","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-03-16","2021-07-20","2021-07-20","2021-03-09","2021-03-09","2021-03-09","2021-04-13","2021-04-13","2021-03-16"],"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":[["","406048401","ACETAMINOPHEN-COD","#3TABLET","30","Select","Select",""],["","67877019805","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","65862006299","METOPROLOL","TARTRATE25MGTAB","60","Select","Select",""],["","16714098801","ROSUVASTATIN","CALCIUM5MGTAB","15","Select","Select",""],["","65862014505","CARVEDILOL","25MGTABLET","60","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","9","Select","Select",""],["","68462018022","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","29300046805","CLONIDINE","HCL0.1MGTABLET","30","Select","Select",""],["","58657067601","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","16571066401","METRONIDAZOLE","500MGTABLET","14","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":""}]}]}