{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Estrella Gonzalez","gend":1,"add":"1437 Hudgins Dr","city":"Gainesville","state":"GA","zip":30504,"dob":"1997-02-25","age":"","mstatus":"","insh":2045814002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Alfredo Jaume","ppno":"","pcpadd":"1400 River Pl","pcpcity":"Braselton","pcpstate":"GA","pcpzip":"","pcpcounty":"Braselton","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":["Z30.016","R79.89","Z23","J45.30","Z68.20","Z01.419","Z11.3","N94.6","N76.0","N94.10","B37.3","B96.89","Z00.00","Z13.89","L24.0","F41.8","F31.9","Q21.0","Z30.8","N93.9","L65.9","L50.9","R11.2","R19.7","T38.4X5","D22.9","D48.5","Z20.822","D22.5","R20.2","N94.19","Z12.4","J30.9","R21","L65.0","L21.9"],"date":["2020-03-03","2021-07-06","2021-07-06","2021-10-19","2021-08-31","2021-06-08","2021-05-11","2020-02-25","2020-05-26","2021-05-11","2020-05-26","2020-05-26","2021-04-27","2021-04-13","2020-03-31","2021-04-13","2021-04-13","2020-03-31","2021-05-11","2021-05-11","2021-05-11","2021-07-06","2021-09-07","2021-09-07","2020-12-08","2020-10-20","2020-10-06","2021-08-31","2020-10-06","2021-04-13","2020-08-04","2021-06-08","2021-07-06","2020-10-20","2020-07-07","2020-07-07"],"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":[["","50111033401","METRONIDAZOLE","500MGTABLET","14","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","68180086473","BLISOVI","24FETABLET","28","Select","Select",""],["","69097081312","GABAPENTIN","100MGCAPSULE","90","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","185094098","CHOLESTYRAMINE","PACKET","10","Select","Select",""],["","172392670","DIAZEPAM","5MGTABLET","1","Select","Select",""],["","555902658","JUNEL","FE1MG-20MCGTABLET","28","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","69097014260","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","14539067401","HYDROXYZINE","PAM25MGCAP","15","Select","Select",""],["","70710113908","FLUCONAZOLE","150MGTABLET","2","Select","Select",""],["","17478071130","LIDOCAINE","HCL0.02JELLY","30","Select","Select",""],["","51672300302","HYDROCORTISONE","0.025CREAM","28.35","Select","Select",""],["","65862057490","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","65862039010","ONDANSETRON","ODT4MGTABLET","20","Select","Select",""],["","143312601","DICYCLOMINE","10MGCAPSULE","120","Select","Select",""],["","45802046564","KETOCONAZOLE","0.02SHAMPOO","120","Select","Select",""],["","378334053","XULANE","PATCH","3","Select","Select",""],["","430042014","LO","LOESTRINFE44835TABLET","28","Select","Select",""],["","68180016011","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","64380071207","BENZONATATE","100MGCAPSULE","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":""}]}]}