{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nevada L Allison","gend":1,"add":"1776 Candler Rd","city":"Gainesville","state":"GA","zip":30507,"dob":"1985-01-18","age":"","mstatus":"","insh":1673128001,"cliId":"","pno":6788365266,"cno":"","email":"nevalsmith@yahoo.com","ename":"","eno":"","pphy":"Amber French","ppno":"","pcpadd":"1315 Jesse Jewell Parkway NE Ste 200","pcpcity":"Gainesville","pcpstate":"GA","pcpzip":"","pcpcounty":"Gainesville","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":["R92.8","D86.9","Z87.891","Z11.59","K11.23","R23.2","K08.109","R39.9","Z68.26","F31.81","F32.9","F41.1","G47.00","Z68.27","R10.12","R12","H20.012","J01.90","J02.9","K00.0","R35.0","Z01.419","N92.0","Z20.828","Z03.818","D86.89","G50.1","M94.262","M94.261","M25.561","M25.562","M26.611","M26.631","R00.0","G50.0","K29.60","B96.81","K29.80","N85.8","H35.50","H52.03","R51.9","J30.1","L30.9","H04.123","Z68.25","K21.9","Z20.822","N64.52","A04.8","R09.89","R22.9","F41.9","F32.A"],"date":["2021-06-15","2020-07-21","2020-07-21","2020-07-21","2020-11-17","2021-12-28","2021-11-16","2021-08-24","2021-08-24","2021-09-21","2021-11-02","2021-11-02","2021-11-02","2021-12-28","2020-07-21","2020-07-21","2021-12-28","2021-12-16","2021-12-16","2021-11-02","2020-06-16","2020-11-24","2020-07-21","2021-06-01","2021-06-01","2021-02-02","2021-02-09","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-05-25","2021-05-18","2021-02-16","2021-01-26","2020-06-30","2020-06-30","2020-06-30","2020-07-14","2021-01-06","2021-01-06","2021-02-02","2022-01-04","2022-01-04","2022-01-04","2021-06-15","2020-06-30","2021-10-13","2021-06-15","2020-09-15","2020-07-21","2021-12-08","2021-12-08","2021-12-08"],"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":[["","68382000801","LAMOTRIGINE","100MGTABLET","30","Select","Select",""],["","51991074790","DULOXETINE","HCLDR30MGCAP","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","28","Select","Select",""],["","69097084615","CYCLOBENZAPRINE","10MGTABLET","14","Select","Select",""],["","59762371809","TRIAZOLAM","0.25MGTABLET","30","Select","Select",""],["","185041005","BUPROPION","HCLSR100MGTABLET","60","Select","Select",""],["","65862039110","ONDANSETRON","ODT8MGTABLET","6","Select","Select",""],["","406012405","HYDROCODONE-ACETAMIN","7.5-325","30","Select","Select",""],["","527193206","CLARITHROMYCIN","500MGTABLET","28","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","56","Select","Select",""],["","16571068001","CARBAMAZEPINE","ER100MGTABLET","60","Select","Select",""],["","64380080707","IBUPROFEN","800MGTABLET","50","Select","Select",""],["","65924007","DUREZOL","0.0005EYEDROPS","5","Select","Select",""],["","62332000231","FAMOTIDINE","40MGTABLET","60","Select","Select",""],["","69097081307","GABAPENTIN","100MGCAPSULE","30","Select","Select",""],["","68180012201","CEPHALEXIN","500MGCAPSULE","40","Select","Select",""],["","51991090701","TETRACYCLINE","500MGCAPSULE","56","Select","Select",""],["","29300022601","METRONIDAZOLE","250MGTABLET","56","Select","Select",""],["","67877021620","CEFUROXIME","AXETIL500MGTAB","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":""}]}]}