{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"brenda johnson","gend":1,"add":"25 McGhee St SW","city":"Rome","state":"GA","zip":30161,"dob":"1956-09-27","age":"","mstatus":"","insh":1327365001,"cliId":"","pno":7063319290,"cno":"","email":"dj8278909@gmail.com","ename":"","eno":"","pphy":"JAMES DOUGLAS","ppno":"","pcpadd":"15 Riverbend Drive SW Ste 200","pcpcity":"Rome","pcpstate":"GA","pcpzip":"","pcpcounty":"Rome","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":["M21.161","I25.10","Z11.59","I12.9","N18.3","K21.9","E78.5","E03.9","E11.22","Z79.84","Z68.35","Z00.00","R73.02","Z79.899","E78.2","Z51.89","M25.561","Z12.31","E11.9","E03.8","M17.11","G89.18","I10","E03.4","E55.9","G89.4","M15.9","Z20.822","Z96.651","S20.212","W18.00X","R07.89","H43.391","R51.9","R42","Z01.818","M19.90","K58.9","K44.9","F41.9","E66.9","H54.7","R79.89","K52.9","F41.1","M54.6","H54.3","Z20.828","N39.0","M17.12","Z47.1","E04.1","R05","R06.2","R60.9","R06.02","I34.0"],"date":["2020-08-25","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-08-03","2020-08-25","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-05-05","2021-05-04","2021-05-18","2021-08-03","2020-11-24","2020-11-17","2021-08-17","2021-05-18","2021-05-18","2020-11-17","2020-08-25","2021-08-03","2021-05-04","2021-08-03","2021-08-03","2021-05-04","2021-04-13","2020-11-17","2020-05-12","2020-05-12","2020-05-12","2021-09-07","2021-10-12","2021-09-07","2020-06-16","2020-06-16","2021-08-03","2020-06-16","2020-06-16","2020-06-16","2021-10-12","2020-04-09","2021-07-06","2021-08-03","2021-08-03","2021-08-03","2020-10-20","2020-12-08","2020-07-14","2020-10-20","2020-06-02","2020-06-02","2021-05-04","2021-07-06","2021-06-01","2021-06-01"],"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":[["","67877019810","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","42571014405","CELECOXIB","200MGCAPSULE","30","Select","Select",""],["","49281072010","FLUBLOK","QUAD2020-2021SYRINGE","0.5","Select","Select",""],["","68382000116","PAROXETINE","HCL40MGTABLET","30","Select","Select",""],["","47781064310","LEVOTHYROXINE","50MCGTABLET","30","Select","Select",""],["","50261010418","IMVEXXY","4MCGSTARTERPACK","18","Select","Select",""],["","49483062350","METFORMIN","HCLER500MGTABLET","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","27808003603","HYDROCODONE-ACETAMIN","7.5-325","30","Select","Select",""],["","62756035664","ONDANSETRON","ODT8MGTABLET","24","Select","Select",""],["","536105429","ASPIRIN","325MGTABLET","30","Select","Select",""],["","47781030301","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","31722094905","OXYCODONE-ACETAMINOPHEN","5-325","40","Select","Select",""],["","67877049090","EZETIMIBE","10MGTABLET","30","Select","Select",""],["","43199001101","HYOSCYAMINE","0.125MGTABSL","60","Select","Select",""],["","64980044115","CLOBETASOL","0.0005CREAM","15","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":""}]}]}