{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beatriz Trejo","gend":1,"add":"3652 Quincy Pl","city":"Gainesville","state":"GA","zip":30504,"dob":"1979-08-25","age":"","mstatus":"","insh":2263053001,"cliId":"","pno":6783165171,"cno":"","email":"bfigueroa130@yahoo.com","ename":"","eno":"","pphy":"MORRIS PULLIAM","ppno":"","pcpadd":"274 Big A Rd","pcpcity":"Toccoa","pcpstate":"GA","pcpzip":"","pcpcounty":"Toccoa","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":["J02.9","Z20.828","J06.9","M54.5","M54.2","S93.432","R07.0","R09.81","H92.01","J30.2","J02.0","H10.13","R05","R29.898","Z01.419","Z12.4","U07.1","S60.931","M79.641","R52","J00","Z23","M79.18","Z68.30","S93.402","M76.72","R60.9","J30.89","J45.20","Z68.32","Z00.00","S29.012","J45.909","E11.9","J01.00","R42","H92.03","R00.2","R11.0","Z11.59","Z68.31","R23.2","Z68.29","M54.6","S16.1XX","M25.572","R60.0","Z12.31","G44.219","J01.90","S96.912"],"date":["2021-06-22","2021-09-22","2021-12-08","2021-01-26","2020-12-01","2021-06-15","2020-11-03","2021-12-08","2020-11-03","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2020-04-14","2021-10-05","2021-10-05","2020-08-18","2020-03-12","2020-03-12","2020-08-18","2020-08-18","2021-12-28","2021-01-26","2021-07-06","2021-12-28","2021-06-29","2021-06-29","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2020-03-03","2020-03-03","2020-03-03","2020-08-04","2021-09-21","2021-09-21","2021-09-21","2021-02-23","2021-11-23","2021-12-28","2021-10-05","2021-01-19","2020-02-18","2020-03-03","2021-08-31","2021-08-31","2021-10-05","2021-01-19","2021-07-06","2021-07-06"],"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":[["","70010077001","METHOCARBAMOL","750MGTABLET","18","Select","Select",""],["","33342010215","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","59746017306","PREDNISONE","10MGTABLET","18","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","59267100002","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","67877032005","IBUPROFEN","600MGTABLET","12","Select","Select",""],["","62756024064","ONDANSETRON","ODT4MGTABLET","21","Select","Select",""],["","54485925","TRIAZOLAM","0.25MGTABLET","24","Select","Select",""],["","67877057505","BENZONATATE","200MGCAPSULE","30","Select","Select",""],["","65162019050","NAPROXEN","500MGTABLET","30","Select","Select",""],["","57237023305","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","61314064511","NEOMYCIN-POLYMYXIN-HC","EARSUSP","10","Select","Select",""],["","93031401","KETOROLAC","10MGTABLET","20","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":""}]}]}