{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Coy Duffey","gend":0,"add":"1004 Escalon Dr","city":"Rossville","state":"GA","zip":30741,"dob":"1956-12-06","age":"","mstatus":"","insh":1392105001,"cliId":"","pno":7066189724,"cno":"","email":"coy.duffeyae@aol.com","ename":"","eno":"","pphy":"JEFFREY CULPEPPER","ppno":"","pcpadd":"6120 Alabama Hwy","pcpcity":"Ringgold","pcpstate":"GA","pcpzip":"","pcpcounty":"Ringgold","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":["Z86.010","L82.1","D22.5","L91.8","L57.0","R07.89","Z87.891","I49.3","E78.2","M54.17","M48.061","M51.26","M51.36","M54.5","E78.5","M19.90","K21.9","E66.9","E55.9","Z87.898","Z68.30","M54.2","M65.342","Z20.828","R10.9"],"date":["2021-09-02","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-02-02","2021-02-02","2021-06-08","2021-06-08","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-02-23","2021-02-23","2021-06-15","2021-02-23"],"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":[["","69097015807","MELOXICAM","7.5MGTABLET","30","Select","Select",""],["","55566670001","CLENPIQ","SOLUTION","320","Select","Select",""],["","70377002811","ATORVASTATIN","20MGTABLET","30","Select","Select",""],["","49281042150","FLUZONE","QUAD2021-2022SYRINGE","0.5","Select","Select",""],["","58160084211","BOOSTRIX","TDAPVACCINEVIAL","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":""}]}]}