{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GARY L EVANS","gend":0,"add":"131 Hine Rd SE","city":"Rome","state":"GA","zip":30161,"dob":"1960-07-07","age":"","mstatus":"","insh":2407568001,"cliId":"","pno":7066765478,"cno":"","email":"ACEGE3116@BELLSOUTH.NET","ename":"","eno":"","pphy":"JAMES WARE","ppno":"","pcpadd":"330 Turner McCall Blvd","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":["J18.9","L71.8","B35.4","D48.5","L57.0","J12.82","R05","R53.83","R50.9","R42","I48.91","Z79.01","Z79.52","I48.0","I42.9","E66.9","Z68.30","Z82.49","Z79.02","Z51.81","Z00.00","E78.00","Z79.899","Z12.5","Z01.84","Z86.79","R00.1","R06.09","Z68.28","U07.1","L56.8","C44.329","I48.92","I44.0","I45.10","R94.31","J06.9","R21","L81.4","L71.9","I34.0","I35.1","Z68.29","L30.9","L82.1","I78.1","L81.8","L91.8","Z01.810","I48.3"],"date":["2021-09-14","2021-05-18","2021-10-20","2021-05-18","2021-10-20","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-12-14","2020-10-06","2020-10-06","2020-10-06","2021-05-11","2020-10-06","2020-10-06","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-10-12","2021-07-06","2021-08-31","2021-07-06","2021-07-06","2021-08-17","2020-10-13","2021-06-08","2020-10-13","2021-08-31","2021-08-31","2021-08-31","2021-09-14","2020-05-19","2021-10-20","2021-10-20","2020-11-17","2020-11-17","2021-12-14","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-10-06","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":[["","54001125","FLECAINIDE","ACETATE100MGTAB","90","Select","Select",""],["","45802013818","CICLOPIROX","0.0077CREAM","90","Select","Select",""],["","50458057930","XARELTO","20MGTABLET","30","Select","Select",""],["","57664050658","METOPROLOL","TARTRATE25MGTAB","30","Select","Select",""],["","67877057305","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","378479106","FLUOROURACIL","0.05CREAM","40","Select","Select",""],["","68382031818","MINOCYCLINE","100MGCAPSULE","60","Select","Select",""],["","69097073102","TERBINAFINE","HCL250MGTABLET","30","Select","Select",""],["","58657050016","CODEINE-GUAIFEN","10-100MG\/5ML","40","Select","Select",""],["","115151258","NAFTIFINE","HCL0.02CREAM","60","Select","Select",""],["","378064205","PREDNISONE","20MGTABLET","6","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","299382345","SOOLANTRA","0.01CREAM","45","Select","Select",""],["","68180071160","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","45802046653","ECONAZOLE","NITRATE0.01CREAM","85","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":""}]}]}