{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Silver K Holmes","gend":1,"add":"515 Santa Claus Rd","city":"Cedartown","state":"GA","zip":30125,"dob":"1973-08-23","age":"","mstatus":"","insh":2010090001,"cliId":"","pno":7705462078,"cno":"","email":"73Silverdollar@gmail.com","ename":"","eno":"","pphy":"NEIL GORDON","ppno":"","pcpadd":"2370 Rockmart Hwy,Suite 10","pcpcity":"Cedartown","pcpstate":"GA","pcpzip":"","pcpcounty":"Cedartown","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":["T78.40X","R22.0","J01.00","E03.9","R41.840","L50.9","L50.0","N30.00","E66.09","Z68.34","M19.90","R30.0","N32.89","N39.0","R21","L29.9","R05","Z82.49","Z03.818","Z11.59","E53.8","F32.0","Z20.822","F90.0","J42","R10.13","F90.9","Z79.899","Z20.828"],"date":["2020-07-21","2020-07-21","2020-02-18","2021-10-19","2021-10-19","2020-03-31","2020-03-31","2020-02-25","2021-10-19","2021-10-19","2020-07-28","2021-11-16","2021-11-16","2021-11-16","2020-03-24","2020-03-24","2020-03-24","2021-11-30","2020-10-06","2020-10-06","2021-10-19","2021-10-19","2021-12-16","2021-07-06","2020-02-04","2020-05-05","2021-03-30","2021-05-11","2021-03-02"],"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":[["","59746017310","PREDNISONE","10MGTABLET","30","Select","Select",""],["","68001000501","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","93030801","CLEMASTINE","FUM2.68MGTAB","40","Select","Select",""],["","57237007630","ONDANSETRON","HCL8MGTABLET","24","Select","Select",""],["","42806034501","DEXTROAMP-AMPHETAMIN","30MGTAB","60","Select","Select",""],["","70436005901","BUPROPION","HCLSR150MGTABLET","30","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","55111012701","CIPROFLOXACIN","HCL500MGTAB","20","Select","Select",""],["","74518290","SYNTHROID","75MCGTABLET","30","Select","Select",""],["","69680011225","CYANOCOBALAMIN","1000MCG\/MLVL","4","Select","Select",""],["","45802016000","DICLOFENAC","SODIUM0.01GEL","100","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","378054101","CIMETIDINE","800MGTABLET","28","Select","Select",""],["","70010077005","METHOCARBAMOL","750MGTABLET","40","Select","Select",""],["","70436015542","PROMETHAZINE-DM","6.25-15MG\/5ML","140","Select","Select",""],["","50111064701","FLUOXETINE","HCL10MGCAPSULE","30","Select","Select",""],["","69367016204","PHENAZOPYRIDINE","100MGTAB","21","Select","Select",""],["","42543040701","POTASSIUM","CITRATEER10MEQTB","30","Select","Select",""],["","80777027398","MODERNA","COVID-19VACCINE(EUA)","0.2","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","93598627","EPINEPHRINE","0.3MGAUTO-INJECT","1","Select","Select",""],["","185067405","HYDROXYZINE","PAM25MGCAP","90","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":""}]}]}