{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lesly B Camacho","gend":1,"add":"1407 Belton Ave","city":"Dalton","state":"GA","zip":30720,"dob":"1989-01-08","age":"","mstatus":"","insh":1492877001,"cliId":"","pno":7069362009,"cno":"","email":"leslycamacho@yahoo.com","ename":"","eno":"","pphy":"Eric Calfee","ppno":"","pcpadd":"105 JW Plaza Drive SE,Suite ","pcpcity":"Calhoun","pcpstate":"GA","pcpzip":"","pcpcounty":"Calhoun","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":["M25.511","M54.50","R51.9","N93.9","Z87.59","Z3A.01","N91.1","O20.0","Z32.01","F41.1","Z00.01","Z12.4","Z13.29","Z13.1","O80","Z37.0","Z3A.37","F32.9","F41.9","O70.0","Z22.330","Z36.85","Z34.03","Z3A.36","B37.3","Z39.2","Z71.7","G44.229","M54.2","O35.8XX","O99.342","Z3A.25","M25.60","Z34.01","Z3A.08","Z71.9","E66.3","F60.3","Z34.02","Z3A.20","Z36.86","Z36.2","Z3A.23","M51.37","M47.816","O42.02","L23.9","H01.119","S91.209","Z39.1","Z34.82","Z34.83","O03.9"],"date":["2021-12-28","2021-12-28","2021-12-28","2020-05-12","2020-05-12","2020-05-19","2020-05-05","2020-05-19","2020-05-05","2021-12-28","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-01-05","2021-04-27","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-12","2021-03-02","2021-03-02","2021-03-16","2021-03-16","2021-03-16","2020-02-18","2020-02-18","2020-09-22","2020-09-22","2020-09-22","2020-05-12","2020-05-26","2020-05-26","2020-09-15","2020-09-15","2020-03-31","2020-09-15","2020-08-18","2020-08-18","2020-09-15","2020-09-15","2021-11-02","2021-11-02","2021-04-27","2021-09-07","2021-09-07","2021-09-07","2020-12-08","2020-12-08","2020-12-08","2020-03-03"],"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":[["","55111017915","TIZANIDINE","HCL2MGTABLET","30","Select","Select",""],["","49281042050","FLUZONE","QUAD2020-2021SYRINGE","0.5","Select","Select",""],["","69543025850","PREPLUS","CA-FE27MG-FA1MGTB","30","Select","Select",""],["","65862007930","TERBINAFINE","HCL250MGTABLET","30","Select","Select",""],["","65862052830","VENLAFAXINE","HCLER75MGCAP","30","Select","Select",""],["","55111014512","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","45802006335","TRIAMCINOLONE","0.00025CREAM","30","Select","Select",""],["","116200116","CHLORHEXIDINE","0.0012RINSE","473","Select","Select",""],["","58160084211","BOOSTRIX","TDAPVACCINEVIAL","0.5","Select","Select",""],["","31722071390","PANTOPRAZOLE","SODDR40MGTAB","30","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":""}]}]}