{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cory Blackwell","gend":0,"add":"1025 Mount Zion NE Rd","city":"Dalton","state":"GA","zip":30721,"dob":"1983-09-07","age":"","mstatus":"","insh":1525715002,"cliId":"","pno":7062649576,"cno":"","email":"","ename":"","eno":"","pphy":"Christine Danforth","ppno":"","pcpadd":"1008 N 3rd Ave","pcpcity":"Chatsworth","pcpstate":"GA","pcpzip":"","pcpcounty":"Chatsworth","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":["J20.8","R53.83","F32.A","K21.9","J30.9","E78.5","H66.001","R68.89","Z91.013","R07.0","J30.2","J45.20","I10","G47.33"],"date":["2021-11-30","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2020-02-18","2020-02-18","2020-02-18","2021-03-23","2021-03-23","2020-02-18","2020-02-18","2020-02-18"],"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":[["","13668017990","ROSUVASTATIN","CALCIUM5MGTAB","30","Select","Select",""],["","60432060416","PROMETHAZINE-DM","SYRUP","200","Select","Select",""],["","66993001968","ALBUTEROL","HFA90MCGINHALER","18","Select","Select",""],["","31722072610","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","68462043730","OLMESARTAN","MEDOXOMIL20MGTAB","30","Select","Select",""],["","62175013643","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","59762007501","HYDROCORTISONE","20MGTABLET","15","Select","Select",""],["","70436001004","BUPROPION","HCLXL150MGTABLET","30","Select","Select",""],["","173068220","VENTOLIN","HFA90MCGINHALER","18","Select","Select",""],["","115169449","EPINEPHRINE","0.3MGAUTO-INJECT","2","Select","Select",""],["","59762219803","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","16714047802","AMOX-CLAV","875-125MGTABLET","20","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":""}]}]}