{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael G Clemons","gend":0,"add":"78 Starlight Dr","city":"Dahlonega","state":"GA","zip":30533,"dob":"1957-12-15","age":"","mstatus":"","insh":2383062001,"cliId":"","pno":7062655582,"cno":"","email":"key1@windstream.net","ename":"","eno":"","pphy":"GEORGE FAILE","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","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":["C85.98","J02.9","U07.1","R51.9","Z68.31","F33.1","T16.1XX","H61.22","H90.3","M79.89","M79.662","Z85.72","C83.38","Z68.30"],"date":["2020-09-22","2022-01-04","2022-01-04","2022-01-04","2020-04-09","2021-08-17","2021-09-01","2021-09-01","2021-04-27","2021-07-06","2021-07-06","2021-06-15","2020-10-13","2020-10-13"],"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":[["","62756001540","TESTOSTERONE","CYP200MG\/ML","2","Select","Select",""],["","16729021716","SERTRALINE","HCL100MGTABLET","60","Select","Select",""],["","69238116609","DOXEPIN","10MGCAPSULE","60","Select","Select",""],["","65862059401","DIVALPROEX","SODER250MGTAB","120","Select","Select",""],["","143993905","AMOXICILLIN","500MGCAPSULE","12","Select","Select",""],["","713076640","TRIAMCINOLONE","0.001PASTE","5","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","406012305","HYDROCODONE-ACETAMIN","5-325MG","10","Select","Select",""],["","406055201","OXYCODONE","HCL5MGTABLET","12","Select","Select",""],["","61314064705","TOBRAMYCIN-DEXAMETH","OPHTHSUSP","5","Select","Select",""],["","116200116","CHLORHEXIDINE","0.0012RINSE","473","Select","Select",""],["","54317757","DEXAMETHASONE","0.5MG\/5MLLIQ","250","Select","Select",""],["","406048410","ACETAMINOPHEN-COD","#3TABLET","10","Select","Select",""],["","54350049","LIDOCAINE","0.02VISCOUSSOLN","100","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":""}]}]}