{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMILA AMJAD","gend":1,"add":"1683 ROSS TRAIL","city":"DALTON","state":"GA","zip":30721,"dob":"1978-02-13","age":"","mstatus":"","insh":1281965002,"cliId":"","pno":7062261516,"cno":"","email":"","ename":"","eno":"","pphy":"AZHAR NISAR","ppno":"","pcpadd":"1407 Chattanooga Ave,Suite ","pcpcity":"Dalton","pcpstate":"GA","pcpzip":"","pcpcounty":"Dalton","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":["J45.909","K21.9","E11.9","G89.4","E53.9","E11.40","M17.9","Z12.31","E78.49","I10","R10.33","Z23","Z20.828","E55.9","E66.8","E78.5","Z00.8","Z13.89","M51.36","R10.30","R07.89","Z01.411","J06.9","R30.0"],"date":["2021-10-26","2021-10-26","2021-09-28","2021-09-28","2021-09-28","2021-10-26","2020-11-03","2020-12-29","2021-10-19","2021-10-19","2021-10-19","2020-10-13","2021-10-20","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-20","2020-08-04","2021-11-02","2020-10-20","2021-10-26","2021-10-26"],"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":[["","43547040111","FUROSEMIDE","20MGTABLET","30","Select","Select",""],["","72205002790","ROSUVASTATIN","CALCIUM5MGTAB","30","Select","Select",""],["","57237002801","AMOXICILLIN","500MGTABLET","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","68645058259","METFORMIN","HCL500MGTABLET","120","Select","Select",""],["","832532211","POTASSIUM","CLER8MEQTABLET","30","Select","Select",""],["","65862046899","LOSARTAN-HCTZ","50-12.5MGTAB","30","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}