{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Shelia Forrester","gend":1,"add":"998 Lakeshore Dr","city":"Gainesville","state":"GA","zip":30501,"dob":"1963-04-18","age":"","mstatus":"","insh":1790769001,"cliId":"","pno":7705341454,"cno":"","email":"chaseforrester878@icloud.com","ename":"","eno":"","pphy":"Kenneth Fogarty","ppno":"","pcpadd":"2350 Limestone Pkwy","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":["F43.23","Z01.419","N39.3","Z68.32","Z80.3","N95.2","N81.10","N81.6","D22.5","L82.1","L81.4","C50.811","Z13.31","Z17.0","M85.80","K21.9","N95.1","R05","R19.7","Z90.13","J02.0","R11.0","R51","J40","J02.9","J03.90","G50.0","H43.393","H25.813","H53.021","H52.7","Z85.3","Z68.28","Z20.822","U07.1","R05.9","R50.9","H04.123","L60.3","L60.8","M25.511","M54.12","M75.30","G89.29","Z68.29","M75.31","Z00.00","J06.9","M85.89","J30.9","R09.81","M89.9","L57.0","B07.8","E78.5","Z78.0","Z20.828","D23.72","L84","Z23"],"date":["2021-10-13","2020-01-14","2020-01-14","2020-08-11","2021-08-10","2020-01-14","2020-01-14","2020-01-14","2021-10-20","2021-10-20","2020-09-29","2020-08-11","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-09-28","2021-08-10","2021-08-10","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2021-11-02","2021-11-02","2020-03-12","2020-03-12","2021-03-23","2020-03-12","2021-03-23","2021-08-10","2021-08-10","2021-12-16","2020-11-03","2021-11-09","2021-11-09","2021-03-23","2021-10-20","2021-08-10","2021-11-30","2021-12-14","2021-10-26","2021-11-30","2021-12-14","2021-12-14","2021-07-27","2021-09-28","2021-06-29","2021-12-16","2021-12-16","2020-03-03","2021-10-20","2021-10-20","2021-06-29","2021-03-30","2020-10-27","2021-10-20","2021-10-20","2021-08-17"],"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":[["","65862022660","CLARITHROMYCIN","500MGTABLET","20","Select","Select",""],["","59746017310","PREDNISONE","10MGTABLET","12","Select","Select",""],["","16714047802","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","65862039010","ONDANSETRON","ODT4MGTABLET","5","Select","Select",""],["","69238110005","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","603459315","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","59762219803","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","173068220","VENTOLIN","HFA90MCGINHALER","18","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","118","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":""}]}]}