{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Douglas Myers","gend":0,"add":"117 Maryann St","city":"Ellijay","state":"GA","zip":30540,"dob":"1962-05-23","age":"","mstatus":"","insh":3621425001,"cliId":"","pno":7065025999,"cno":"","email":"douglasmyers60@gmail.com","ename":"","eno":"","pphy":"Thomas Nguyen","ppno":"","pcpadd":"822 Industrial Blvd,Suite ","pcpcity":"Ellijay","pcpstate":"GA","pcpzip":"","pcpcounty":"Ellijay","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":["F17.210","M19.90","F41.9","Z97.2","Z79.899","Z80.3","Z82.49","M15.0","F33.1","Z96.649","B19.20","Z86.11","Z86.19","R20.2","F41.1","B18.2","M25.552","E66.3","Z68.25","E11.9","I10","E78.5","E03.9","Z12.5","R53.83","Z00.00","M16.12","M54.5","R10.2","Z01.818","Z68.24","K21.9","Z72.51","E78.2","R94.5","Z20.822","R51.9","Z11.52","B37.42","T81.41X","A49.02","Z96.642","M87.052","R26.2","N52.8","U07.1","R03.0","M25.452","L02.416","M79.89","Z47.1"],"date":["2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-10-26","2021-10-26","2021-02-02","2021-02-02","2021-02-02","2020-06-02","2020-06-02","2021-10-26","2020-11-17","2020-11-24","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2021-06-15","2020-08-04","2021-01-19","2020-07-14","2020-08-18","2021-01-05","2021-07-20","2020-05-19","2021-02-02","2020-08-04","2020-08-04","2021-09-14","2021-06-15","2021-06-15","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2020-08-11","2020-07-14","2021-07-20","2021-09-14","2021-10-26","2020-09-01","2021-02-02","2021-01-12","2021-01-12"],"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":[["","781729685","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","65862052899","VENLAFAXINE","HCLER75MGCAP","30","Select","Select",""],["","93083205","CLONAZEPAM","0.5MGTABLET","50","Select","Select",""],["","378415105","TRAMADOL","HCL50MGTABLET","30","Select","Select",""],["","16714066202","GABAPENTIN","300MGCAPSULE","30","Select","Select",""],["","16714095502","KETOCONAZOLE","0.02CREAM","30","Select","Select",""],["","72626260101","LEDIPASVIR-SOFOSBUVIR","90-400MG","28","Select","Select",""],["","65862041905","SULFAMETHOXAZOLE-TMP","SSTABLET","28","Select","Select",""],["","62175061746","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","43547028010","ESCITALOPRAM","5MGTABLET","30","Select","Select",""],["","31722094901","OXYCODONE-ACETAMINOPHEN","5-325","30","Select","Select",""],["","42806031205","DOXYCYCLINE","HYCLATE100MGTAB","28","Select","Select",""],["","16714007104","BACLOFEN","10MGTABLET","20","Select","Select",""],["","54418625","DEXAMETHASONE","6MGTABLET","10","Select","Select",""],["","16571020150","DICLOFENAC","SODEC75MGTAB","20","Select","Select",""],["","16714038802","CEFADROXIL","500MGCAPSULE","28","Select","Select",""],["","904675180","ASPIRIN","EC81MGTABLET","60","Select","Select",""],["","70010075405","METHOCARBAMOL","500MGTABLET","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":""}]}]}