{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna A Stuart","gend":1,"add":"40 Oak Hill Dr","city":"Mineral Bluff","state":"GA","zip":30559,"dob":"1960-11-01","age":"","mstatus":"","insh":3607029001,"cliId":"","pno":6788773999,"cno":"","email":"donnastuart1982@yahoo.com","ename":"","eno":"","pphy":"ELIAS ISSA","ppno":"","pcpadd":"166 Industrial Dr","pcpcity":"Ducktown","pcpstate":"TN","pcpzip":"","pcpcounty":"Ducktown","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":["L82.1","D22.5","Z87.2","Z85.828","L57.0","D48.5","Z08","I10","F17.200","Z88.1","Z80.52","Z80.0","Z82.49","D47.3","D51.8","L98.499","C44.729","K21.9","E78.5","E55.9","E53.8","Z91.013","L21.8","L20.89","Z48.02","D04.71","R92.2","R92.0","C44.529","L23.5","N60.31","J01.90","D03.61","Z23","Z12.11","D04.72","D04.62","L90.5"],"date":["2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-09-22","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2021-06-22","2021-06-22","2021-10-12","2022-01-04","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2020-11-10","2020-11-10","2021-08-24","2021-08-03","2021-06-01","2020-03-17","2021-06-08","2020-08-04","2021-06-15","2021-06-29","2021-12-14","2021-04-06","2020-03-31","2021-11-09","2021-11-09","2021-06-15"],"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":[["","16729018201","HYDROCHLOROTHIAZIDE","12.5MGTB","60","Select","Select",""],["","93101042","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","93321930","KETOCONAZOLE","0.02CREAM","60","Select","Select",""],["","43547035311","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","115169449","EPINEPHRINE","0.3MGAUTO-INJECT","2","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","65862050220","AMOX-CLAV","500-125MGTABLET","30","Select","Select",""],["","70461042010","FLUCELVAX","QUAD2020-2021VIAL","0.5","Select","Select",""],["","378479106","FLUOROURACIL","0.05CREAM","40","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","12","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","30","Select","Select",""],["","80777027315","MODERNA","COVID-19VACCINE(EUA)","0.2","Select","Select",""],["","33342032980","TRIAMCINOLONE","0.001CREAM","80","Select","Select",""],["","68180016013","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","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":["",""]}},{"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":""}]}]}