{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael Jason Bowers","gend":0,"add":"265 Oakwood Circle","city":"Chatsworth","state":"GA","zip":30705,"dob":"1970-05-11","age":"","mstatus":"","insh":1581291002,"cliId":"","pno":7062809978,"cno":"","email":"","ename":"","eno":"","pphy":"Tom Bledsoe","ppno":"","pcpadd":"45 College Park Dr,Suite ","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":["M25.511","R07.0","R03.0","I10","J01.80","E78.49","M75.121","Z98.890","G89.18","M75.101","Z71.9","M54.5","M75.21","K21.9","F17.290","E66.9","E78.5","M79.671"],"date":["2020-05-05","2020-07-07","2020-07-07","2021-03-09","2020-07-07","2021-03-09","2020-09-01","2020-09-01","2020-05-05","2020-05-05","2020-09-01","2021-01-26","2020-05-19","2020-05-19","2020-05-19","2020-03-12","2020-11-24","2020-11-24"],"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":[["","68180098003","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","55111012105","ATORVASTATIN","10MGTABLET","30","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","93031401","KETOROLAC","10MGTABLET","21","Select","Select",""],["","406051205","OXYCODONE-ACETAMINOPHEN","5-325","30","Select","Select",""],["","66685100100","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","65862001705","AMOXICILLIN","500MGCAPSULE","28","Select","Select",""],["","406012305","HYDROCODONE-ACETAMIN","5-325MG","16","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","12","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":""}]}]}