{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEANNE NASWORTHY","gend":1,"add":"16 Kris Dr NE","city":"Rome","state":"GA","zip":30161,"dob":"1958-09-08","age":"","mstatus":"","insh":1372860001,"cliId":"","pno":7064915226,"cno":"","email":"jeanne.nasworthy58@gmail.com","ename":"","eno":"","pphy":"ROBERT SMITH","ppno":"","pcpadd":"1825 Martha Berry Boulevard NW","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":["D64.9","Z00.00","E78.2","I10","Z12.11","Z12.31","K21.9","J01.90","F33.0","Z68.35","Z68.36","N18.32","M19.042","Z68.38","G89.4","M51.36","M54.16","M25.562","M50.322","M46.86","Z79.891","N18.9","Z79.899","Z01.419","Z12.12","N76.2","Z68.34","M79.642","M18.0"],"date":["2021-11-23","2021-03-16","2021-11-23","2021-11-23","2021-07-20","2021-05-04","2021-03-16","2021-07-20","2021-03-16","2021-03-16","2021-07-20","2021-11-09","2021-08-31","2021-11-23","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-14","2021-10-06","2021-04-20","2021-03-23","2021-03-23","2021-03-23","2021-07-27","2021-08-24"],"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":[["","53489011905","DOXYCYCLINE","HYCLATE100MGCAP","28","Select","Select",""],["","31722070430","VALACYCLOVIR","HCL500MGTABLET","30","Select","Select",""],["","13668013601","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","60505025203","TIZANIDINE","HCL4MGTABLET","30","Select","Select",""],["","65862057490","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","68180072003","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","70377000712","ROSUVASTATIN","CALCIUM10MGTAB","30","Select","Select",""],["","93221001","SUCRALFATE","1GMTABLET","60","Select","Select",""],["","33342007810","VALSARTAN-HCTZ","320-25MGTAB","30","Select","Select",""],["","76385011150","CARVEDILOL","6.25MGTABLET","60","Select","Select",""],["","59267100002","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","69452020720","CALCITRIOL","0.25MCGCAPSULE","30","Select","Select",""],["","43386035801","HYDROCODONE-ACETAMIN","10-325MG","30","Select","Select",""],["","67877025130","TRIAMCINOLONE","0.001CREAM","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","70461032103","FLUCELVAX","QUAD2021-2022SYR","0.5","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":""}]}]}