{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ader Cordero Gomez","gend":1,"add":"219 Lynn Ln","city":"Cedartown","state":"GA","zip":30125,"dob":"1963-12-07","age":"","mstatus":"","insh":1644822002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Julaine Cross","ppno":"","pcpadd":"11766 Hwy 27 N","pcpcity":"Summerville","pcpstate":"GA","pcpzip":"","pcpcounty":"Summerville","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":["I10","E78.5","E66.9","E55.9","M54.2","M54.9","E04.1","K57.30","K64.8","J06.9","S49.91X","S79.919","S19.9XX","R51.9","N95.1","F41.9","F32.9","R73.03","R74.8","Z00.00","Z01.419","Z23","Z12.11","I45.10","R94.31","S46.911","G89.11","M54.5","K21.9","G43.909","Z12.31","S19.89X","S29.8XX","S49.81X","V43.62X","Y92.488","H53.8","E04.2","S39.91X","S29.9XX","R07.9","R10.9"],"date":["2020-09-22","2021-03-23","2020-10-06","2021-03-23","2021-04-20","2021-04-20","2021-05-11","2020-11-17","2020-11-17","2021-05-11","2021-05-11","2021-05-11","2021-04-13","2021-04-13","2021-03-23","2020-10-06","2020-10-06","2021-03-23","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-11-17","2021-03-23","2021-03-23","2021-05-11","2021-05-11","2021-03-23","2021-03-23","2021-03-23","2020-11-24","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2020-11-03","2021-06-01","2021-05-11","2021-05-11","2021-05-11","2021-05-11"],"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":[["","70377002911","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","31722053401","METHOCARBAMOL","750MGTABLET","18","Select","Select",""],["","52817033010","CYCLOBENZAPRINE","5MGTABLET","60","Select","Select",""],["","13668000901","CITALOPRAM","HBR10MGTABLET","30","Select","Select",""],["","17772010230","TROKENDI","XR50MGCAPSULE","30","Select","Select",""],["","29300012401","MELOXICAM","7.5MGTABLET","30","Select","Select",""],["","93031401","KETOROLAC","10MGTABLET","20","Select","Select",""],["","67877041305","METFORMIN","HCLER500MGTABLET","60","Select","Select",""],["","55111029309","SUMATRIPTAN","SUCC100MGTABLET","9","Select","Select",""],["","10572030201","PEG","3350-ELECTROLYTESOLUTION","4000","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":""}]}]}