{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robin Chamberlain","gend":1,"add":"757 Wildflower Cir","city":"Clarkesville","state":"GA","zip":30523,"dob":"1959-09-18","age":"","mstatus":"","insh":1288345001,"cliId":"","pno":7708833440,"cno":"","email":"robinchamberlain@cheechytees.com","ename":"","eno":"","pphy":"William Koeppel","ppno":"","pcpadd":"396 Historic Hwy 441 N","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":["F31.9","Z00.8","Z20.828","E78.2","R73.03","R79.89","Z86.39","E55.9","F12.10","Z00.00","E11.65","Z23","Z13.31","F39","Z68.26","F15.159","I51.7","R94.31","F51.01","F31.81","G47.00","F19.959","F17.210","F31.2","L25.5","Z68.25","F20.9","Z68.24","F29","F22","F17.200","F90.0","M76.32","R07.9"],"date":["2020-08-11","2020-08-11","2020-08-11","2021-10-19","2020-06-02","2021-10-19","2021-10-19","2021-10-19","2020-07-07","2021-10-19","2021-10-19","2021-12-14","2021-10-19","2021-10-19","2021-10-19","2020-08-04","2020-08-11","2020-08-11","2020-06-02","2020-07-21","2020-07-21","2020-03-03","2020-03-03","2020-11-03","2020-08-04","2020-08-04","2020-07-07","2020-05-26","2020-02-25","2020-02-11","2021-08-24","2020-03-17","2020-03-17","2020-08-11"],"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":[["","93720198","PRAVASTATIN","SODIUM20MGTAB","30","Select","Select",""],["","57237004705","DIVALPROEX","SODDR250MGTAB","60","Select","Select",""],["","68382080601","TRAZODONE","100MGTABLET","30","Select","Select",""],["","591544305","PREDNISONE","20MGTABLET","10","Select","Select",""],["","67877056105","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","43598044828","NICOTINE","21MG\/24HRPATCH","28","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","55111025960","ZIPRASIDONE","HCL80MGCAPSULE","30","Select","Select",""],["","43547028910","BUPROPION","HCLSR150MGTABLET","58","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","43547034050","RISPERIDONE","0.5MGTABLET","60","Select","Select",""],["","70461032003","FLUCELVAX","QUAD2020-2021SYR","0.5","Select","Select",""],["","54050823","ICOSAPENT","ETHYL1GRAMCAPSULE","120","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":""}]}]}