{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marilyn R Hayes","gend":1,"add":"1162 Baxter Rd NE","city":"Resaca","state":"GA","zip":30735,"dob":"1957-05-04","age":"","mstatus":"","insh":1913417001,"cliId":"","pno":7066252796,"cno":"","email":"dogularity@iwispr.net","ename":"","eno":"","pphy":"Robert Lester","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","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":["C50.412","D05.12","N95.1","Z17.0","Z85.3","C50.911","Z20.822","F41.8","E66.9","Z68.35","K21.9","F43.10","Z68.34","N64.52","C50.912","D36.0","N95.8","L30.4","L82.1","D22.5","L57.0","F41.9","C50.919","A63.0","N63.25","M50.31","M47.812","M50.221","M48.02","F33.9","F41.1","F41.0","R92.8","M18.12","M75.82","M19.012","C50.812","Z80.0","Z80.3","Z01.812","Z12.39","N63.21","K62.82"],"date":["2021-11-18","2021-11-18","2021-08-04","2021-11-18","2021-09-07","2021-08-10","2021-09-07","2021-09-07","2021-10-26","2021-10-26","2021-10-26","2021-08-17","2021-08-17","2021-04-20","2021-08-10","2021-04-27","2021-07-27","2021-03-30","2021-11-09","2021-11-09","2021-11-09","2022-01-04","2022-01-04","2021-10-26","2021-04-20","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-09-07","2021-09-07","2021-09-07","2021-05-18","2021-03-02","2021-03-02","2021-03-02","2021-06-08","2021-04-06","2021-04-06","2021-10-12","2021-03-30","2021-04-27","2021-09-21"],"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":[["","406051205","OXYCODONE-ACETAMINOPHEN","5-325","20","Select","Select",""],["","832059530","EXEMESTANE","25MGTABLET","30","Select","Select",""],["","16729013600","CLONAZEPAM","0.5MGTABLET","30","Select","Select",""],["","16729003510","ANASTROZOLE","1MGTABLET","30","Select","Select",""],["","59746017310","PREDNISONE","10MGTABLET","30","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":""}]}]}