{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tammy B Parks","gend":1,"add":"285 Youngs Valley Rd","city":"Buchanan","state":"GA","zip":30113,"dob":"1969-12-10","age":"","mstatus":"","insh":2219246001,"cliId":"","pno":7705461463,"cno":"","email":"tammy.parks@dempseyi.com","ename":"","eno":"","pphy":"RAYMOND MCKOY","ppno":"","pcpadd":"310 W 10th St","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":["Z51.81","F41.9","R31.9","N28.1","I10","D50.9","Z13.220","Z13.21","Z79.891","N20.0","N39.0","R10.9","G47.09","M54.5","D25.9","F33.1"],"date":["2020-12-15","2020-12-15","2020-03-10","2020-01-22","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-05-19","2020-04-21","2020-03-17","2020-03-17","2020-07-28","2020-06-02","2020-03-12","2020-06-02"],"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":[["","13668001105","CITALOPRAM","HBR40MGTABLET","30","Select","Select",""],["","64380080707","IBUPROFEN","800MGTABLET","90","Select","Select",""],["","16729020201","BUSPIRONE","HCL10MGTABLET","150","Select","Select",""],["","70710116801","ATENOLOL-CHLORTHALIDONE","100-25","45","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MGTABLET","90","Select","Select",""],["","13668000805","ZOLPIDEM","TARTRATE10MGTABLET","30","Select","Select",""],["","781724964","BUPRENOR-NALOX","44632MGSLFILM","30","Select","Select",""],["","47781030701","NITROFURANTOIN","MCR50MGCAP","30","Select","Select",""],["","65162052110","PROMETHAZINE","25MGTABLET","15","Select","Select",""],["","245531990","KLOR-CON","M20TABLET","30","Select","Select",""],["","70710114003","FLUCONAZOLE","200MGTABLET","1","Select","Select",""],["","68180071160","CEFDINIR","300MGCAPSULE","14","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":""}]}]}