{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Randy Snow","gend":0,"add":"738 Watkins Field Rd","city":"Clayton","state":"GA","zip":30525,"dob":"1956-11-22","age":"","mstatus":"","insh":361581001,"cliId":"","pno":7064909120,"cno":"","email":"randy56snow@gmail.com","ename":"","eno":"","pphy":"EDWARD FREDERICKSON","ppno":"","pcpadd":"156 North Main Street,N","pcpcity":"Clayton","pcpstate":"GA","pcpzip":"","pcpcounty":"Clayton","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":["M48.02","M47.22","M54.2","M46.92","M25.511","M46.1","G89.29","Z79.891","M54.31","M76.899","M25.551","M54.5","M47.892","M47.816","K80.20","G89.4","M54.16","M51.34","F11.20","F41.9","I10","J43.1","M25.561","R35.0","Z79.899","J20.8","R10.84","Z23","R19.7","M54.40","J44.9","R05.3"],"date":["2021-11-23","2021-08-24","2021-11-09","2020-07-07","2021-02-23","2021-05-25","2021-11-09","2021-11-09","2020-12-29","2020-12-01","2020-12-01","2021-08-24","2020-11-10","2020-11-24","2020-11-24","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-11-09","2021-11-23","2021-11-23","2021-05-25","2020-08-25","2020-08-25","2020-12-29","2020-12-29","2021-11-23","2020-10-13","2020-11-10","2020-11-24","2021-11-23"],"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":[["","68180072103","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","68180037803","LOSARTAN","POTASSIUM100MGTAB","30","Select","Select",""],["","69097014260","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","228202796","ALPRAZOLAM","0.25MGTABLET","28","Select","Select",""],["","115168974","BUDESONIDE","0.5MG\/2MLSUSP","60","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","54004641","IPRATROPIUM","0.0006SPRAY","15","Select","Select",""],["","406012505","HYDROCODONE-ACETAMIN","10-325MG","168","Select","Select",""],["","65862046990","LOSARTAN-HCTZ","100-12.5MGTAB","30","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","80777027398","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","527217037","DICLOFENAC","SODER100MGTAB","30","Select","Select",""],["","93075305","ATENOLOL","100MGTABLET","30","Select","Select",""],["","51224012250","AZITHROMYCIN","500MGTABLET","20","Select","Select",""],["","591544305","PREDNISONE","20MGTABLET","10","Select","Select",""],["","65862017760","CEFDINIR","300MGCAPSULE","28","Select","Select",""],["","70069000510","CYANOCOBALAMIN","1000MCG\/MLVL","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":""}]}]}