{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rickey Gooch","gend":0,"add":"34 Gooch Rd","city":"Dahlonega","state":"GA","zip":30533,"dob":"1957-03-11","age":"","mstatus":"","insh":2184066001,"cliId":"","pno":6783162388,"cno":"","email":"rickeygooch@yahoo.com","ename":"","eno":"","pphy":"Donna Whitfield","ppno":"","pcpadd":"743 Spring St","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":["Z86.16","I10","E78.5","E03.8","C09.9","C77.0","S14.3XX","E78.2","E04.1","Z85.818","M25.612","G54.0","M62.512","M79.602","E03.9","K22.2","R10.13","R13.10","Z20.828","E53.8","R53.83","K29.50","K21.9","R42","R55","Z68.25","Z11.59","D22.61","L81.4","D22.4","L57.0","L03.213","Z12.5","M70.22","N40.1","Z53.29","Z79.899","Z79.82","Z88.5","Z82.49","Z80.8","Z12.11","R53.1","Z92.3","R10.9","I77.9","Z85.89","M47.12","M25.512","G89.29","H00.14","H25.13","R35.1","Z00.00","H25.813","H04.123","H52.13","H52.4","Z71.89","R63.8","Z68.26","R79.89","I70.90","Z91.89","N52.9","M50.322","M99.71","M79.2"],"date":["2021-08-10","2021-11-23","2021-11-23","2021-11-23","2021-06-08","2021-06-08","2020-07-28","2021-03-23","2020-12-01","2020-07-21","2020-03-12","2021-06-08","2020-03-12","2020-03-12","2021-08-10","2020-12-29","2021-01-19","2021-01-19","2020-12-29","2020-12-01","2020-11-17","2020-12-22","2021-03-23","2020-09-15","2020-09-15","2021-01-26","2020-06-23","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2020-07-21","2020-11-17","2021-01-26","2021-03-23","2021-03-23","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-03-23","2020-03-17","2020-03-17","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2020-07-28","2020-07-28","2020-12-01","2021-12-07","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2021-12-07","2021-12-07","2021-12-07","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-05-19","2020-05-19","2020-04-14"],"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":[["","93762598","PREGABALIN","100MGCAPSULE","90","Select","Select",""],["","68180098103","LISINOPRIL","20MGTABLET","30","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","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":""}]}]}