{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLENN J Arnold","gend":0,"add":"52 McCollum Rd","city":"Ellijay","state":"GA","zip":30540,"dob":"1959-10-15","age":"","mstatus":"","insh":2243315001,"cliId":"","pno":7068891363,"cno":"","email":"holcombe.beth@yahoo.com","ename":"","eno":"","pphy":"ALANA KENT","ppno":"","pcpadd":"14244 Highway 515 N,Suite 10","pcpcity":"Ellijay","pcpstate":"GA","pcpzip":"","pcpcounty":"Ellijay","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":["R73.01","E78.2","Z12.5","R68.89","E11.9","R97.20","E78.5","K21.9","K22.4","K22.711","I25.10","K44.9","I10","I25.2","M17.12","Z95.5","Z86.010","B02.9","G47.00","N40.1","K80.20","I25.750","K21.0","K22.70","R10.11","K76.0","N40.0","Z79.84","R07.9","Z76.89","I25.110","M54.2","R35.0","R11.0","Z80.0","Z48.89","K81.9"],"date":["2020-11-03","2020-11-03","2020-11-03","2020-11-03","2021-05-04","2021-06-15","2021-05-04","2021-04-27","2020-01-28","2020-01-14","2021-04-27","2020-01-14","2021-09-07","2020-01-14","2020-01-14","2020-01-14","2020-01-14","2021-09-07","2021-09-07","2021-07-06","2021-06-15","2020-01-28","2020-01-28","2020-01-28","2021-06-08","2021-02-11","2021-06-22","2021-03-30","2020-02-04","2021-03-09","2020-01-07","2021-04-27","2021-06-15","2021-02-02","2021-02-02","2021-04-13","2021-03-30"],"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":[["","93221001","SUCRALFATE","1GMTABLET","40","Select","Select",""],["","68462010530","ONDANSETRON","HCL4MGTABLET","12","Select","Select",""],["","76385011250","CARVEDILOL","12.5MGTABLET","60","Select","Select",""],["","13668000805","ZOLPIDEM","TARTRATE10MGTABLET","30","Select","Select",""],["","68382075810","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","60505025203","TIZANIDINE","HCL4MGTABLET","90","Select","Select",""],["","70377002711","ATORVASTATIN","10MGTABLET","30","Select","Select",""],["","65862014990","FINASTERIDE","5MGTABLET","30","Select","Select",""],["","42858010201","OXYCODONE-ACETAMINOPHEN","5-325","12","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMIN","5-325MG","12","Select","Select",""],["","31722070530","VALACYCLOVIR","HCL1GRAMTABLET","20","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","69238126601","OSELTAMIVIR","PHOS75MGCAPSULE","10","Select","Select",""],["","57237001401","TAMSULOSIN","HCL0.4MGCAPSULE","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":""}]}]}