{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARADABEN PATEL","gend":1,"add":"504 Valley Dr","city":"Cedartown","state":"GA","zip":30125,"dob":"1948-06-01","age":"","mstatus":"","insh":1784338002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"JAYESH PATEL","ppno":"","pcpadd":"1945 Lake Pointe Drive,N","pcpcity":"Lewisville","pcpstate":"TX","pcpzip":"","pcpcounty":"Lewisville","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"Apt C","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":["K21.9","I10","D50.9","Z68.29","C78.6","C77.2","K31.1","N17.9","R18.0","R64","E46","Z68.1","E55.9","E83.42","K29.70","K31.84","K59.09","Z51.5","Z66","Z79.899","Z99.3","E83.52","E87.6","E53.8","D64.9","J18.9","R57.1","E86.0","E87.1","E87.3","I95.9","R77.8","Z20.822","K27.9","I25.10","E78.5","Z95.5","Z79.82","R06.00","R05","R06.2","R79.89","K44.9","D51.8","R11.2","R63.4","C16.9","Z00.01","Z23","Z12.31","Z12.4","Z12.11","M19.041","Z68.26","H04.123","H35.361","H25.13","R10.2","S39.93X","M19.071","M54.5","R11.0","K59.01","E11.9","R06.1","K29.00","R73.03","M25.512","G89.11","R10.9","R18.8","R19.7","E78.2","M17.0","E66.9","Z68.30","J18.1","M54.2","S19.9XX","R55","S09.90X","S49.92X","C16.3","R07.1","R91.8","R07.9","I34.0","R79.0","I36.1","R94.31","A04.9","I21.4","M79.606","E43","G43.A1","F41.8","Z45.2","Z41.9","M79.89"],"date":["2021-11-09","2021-11-23","2021-09-14","2020-07-28","2021-11-09","2021-11-09","2021-11-09","2021-11-23","2021-11-09","2021-11-09","2021-11-23","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-23","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-23","2021-11-09","2021-11-09","2021-11-23","2021-09-14","2021-09-14","2021-09-14","2021-10-06","2021-10-06","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2020-01-28","2021-10-12","2020-01-28","2020-03-10","2020-01-28","2021-08-10","2021-08-10","2021-08-10","2021-11-02","2021-06-08","2021-05-11","2021-05-11","2021-06-08","2021-06-08","2021-09-14","2021-05-11","2021-05-04","2021-05-04","2021-05-04","2021-10-12","2021-10-12","2021-10-13","2021-05-11","2021-05-11","2021-10-20","2020-05-12","2020-05-12","2021-01-06","2021-01-06","2020-06-09","2020-06-09","2021-10-13","2021-11-02","2021-08-31","2020-10-13","2020-02-04","2020-05-12","2020-05-12","2020-03-31","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2020-10-27","2021-10-26","2020-03-10","2021-10-12","2021-10-12","2021-10-13","2021-10-06","2021-10-13","2021-10-13","2020-11-17","2021-09-07","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-12","2021-10-13","2021-10-13"],"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":[["","228282011","HYDROCHLOROTHIAZIDE","12.5MGTB","30","Select","Select",""],["","93220401","METOCLOPRAMIDE","5MGTABLET","60","Select","Select",""],["","55111064505","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","68382013610","LOSARTAN","POTASSIUM50MGTAB","30","Select","Select",""],["","10702025350","BUTALB-ACETAMIN-CAFF","50-325-40","12","Select","Select",""],["","68462015713","ONDANSETRON","ODT4MGTABLET","20","Select","Select",""],["","143992701","CIPROFLOXACIN","HCL250MGTAB","14","Select","Select",""],["","13107000130","MIRTAZAPINE","7.5MGTABLET","30","Select","Select",""],["","121087316","LACTULOSE","10GM\/15MLSOLUTION","473","Select","Select",""],["","50111033401","METRONIDAZOLE","500MGTABLET","21","Select","Select",""],["","781618667","CIPROFLOX-DEXAMETH","OTICSUSP","7.5","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}