{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bryan Tucker","gend":0,"add":"110 DUGDOWN RD","city":"BUCHANAN","state":"GA","zip":30113,"dob":"1961-01-31","age":"","mstatus":"","insh":2025833001,"cliId":"","pno":6787272895,"cno":"","email":"bryantucker316@gmail.com","ename":"","eno":"","pphy":"Jacquelyn Cheatham-Terry","ppno":"","pcpadd":"304 Shorter Ave","pcpcity":"Rome","pcpstate":"GA","pcpzip":"","pcpcounty":"Rome","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":["E11.42","Z79.4","Z96.41","R10.33","H50.9","E10.9","E11.331","H50.05","L30.9","E11.9","E11.40","E78.5","Z12.5","L02.419","L03.115","E11.65","R11.11","B35.1","I87.2","L30.8","L20.9"],"date":["2020-07-07","2021-11-09","2020-04-14","2021-12-28","2020-01-22","2020-07-07","2021-11-09","2020-02-25","2020-02-11","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-04-14","2020-04-14","2021-08-24","2021-12-28","2020-02-18","2020-02-11","2020-02-11","2020-02-18"],"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":[["","45802014167","CICLOPIROX","0.08SOLUTION","6.6","Select","Select",""],["","23155000910","HYDROCHLOROTHIAZIDE","50MGTAB","30","Select","Select",""],["","2751001","HUMALOG","100UNIT\/MLVIAL","30","Select","Select",""],["","99073012101","FREESTYLE","TESTSTRIPS","100","Select","Select",""],["","70377002911","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","93010901","CARBAMAZEPINE","200MGTABLET","120","Select","Select",""],["","63304069301","CLINDAMYCIN","HCL300MGCAPSULE","20","Select","Select",""],["","45802005505","TRIAMCINOLONE","0.001OINTMENT","454","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":""}]}]}