{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Heather Migliore","gend":1,"add":"4263 Wintergreen Ct","city":"Gainesville","state":"GA","zip":30507,"dob":"1979-05-23","age":"","mstatus":"","insh":1677656001,"cliId":"","pno":7705400874,"cno":"","email":"heather.migliore@amfam.com","ename":"","eno":"","pphy":"Eric Bohn","ppno":"","pcpadd":"1515 River Pl Ste 100","pcpcity":"Braselton","pcpstate":"GA","pcpzip":"","pcpcounty":"Braselton","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":["E03.9","L70.9","F41.9","Z00.00","Z68.21","T78.40X","K64.5","K59.09","Z20.828","Z01.419","J02.9","Z03.818","J06.9","R05","K59.04","S39.012","Z68.20","M79.2","M76.71","M62.461","K64.9","K59.00","G40.909","G43.009","Z68.22","R79.89","G25.81","G40.209","Z12.31"],"date":["2021-06-22","2020-12-15","2021-06-15","2020-12-15","2021-06-22","2021-06-22","2020-06-16","2020-06-16","2020-07-21","2020-04-09","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-09-29","2020-06-16","2020-06-16","2021-08-05","2021-08-05","2021-08-05","2020-06-16","2020-06-16","2020-02-11","2020-08-11","2020-02-11","2021-06-15","2021-06-22","2020-08-11","2020-01-28"],"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":[["","68180011316","LEVETIRACETAM","500MGTABLET","60","Select","Select",""],["","69238183201","LEVOTHYROXINE","75MCGTABLET","30","Select","Select",""],["","68382013914","TOPIRAMATE","50MGTABLET","120","Select","Select",""],["","65649000330","TRULANCE","3MGTABLET","30","Select","Select",""],["","527293441","PREDNISONE","20MGTABLET","8","Select","Select",""],["","13668001005","CITALOPRAM","HBR20MGTABLET","30","Select","Select",""],["","16729022601","SPIRONOLACTONE","50MGTABLET","60","Select","Select",""],["","299590645","EPIDUO","FORTE0.3-2.5%GELPUMP","45","Select","Select",""],["","68462015813","ONDANSETRON","ODT8MGTABLET","10","Select","Select",""],["","68382005101","MELOXICAM","15MGTABLET","14","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","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":""}]}]}