{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Melissa Gilbert","gend":1,"add":"55 Pinewood Pl","city":"Dahlonega","state":"GA","zip":30533,"dob":"1968-11-29","age":"","mstatus":"","insh":3646998002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Michael Mulberry","ppno":"","pcpadd":"23 Tipton Dr","pcpcity":"Dahlonega","pcpstate":"GA","pcpzip":"","pcpcounty":"Dahlonega","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":["M72.2","M79.671","M47.816","K63.5","K57.30","K64.8","R42","M54.5","E53.8","E55.9","E86.0","G89.29","Z68.26","Z12.11","Z00.00","Z13.31","Z01.419","I73.9","I83.90","Z12.31","M51.16","M51.36","F06.30","F11.20","F45.8","Z13.89","Z79.891","E08.42","M79.604","M79.605","M79.661","J02.9","U07.1","J01.10","R05","D12.3"],"date":["2021-08-31","2021-11-02","2021-09-14","2021-10-20","2021-10-20","2021-10-20","2021-08-31","2021-07-27","2021-12-28","2021-08-31","2021-07-27","2021-07-27","2021-12-14","2021-11-02","2021-08-31","2021-08-31","2021-09-07","2021-08-31","2021-12-14","2021-09-22","2021-03-09","2020-06-30","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2021-09-14","2021-12-14","2021-12-14","2021-12-14","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-11-02"],"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":[["","43547039910","CYCLOBENZAPRINE","5MGTABLET","30","Select","Select",""],["","80777027398","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","69680011225","CYANOCOBALAMIN","1000MCG\/ML","1","Select","Select",""],["","60505025103","TIZANIDINE","HCL2MGTABLET","90","Select","Select",""],["","68001000501","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","50383027201","DICLOFENAC","SODIUM0.01GEL","100","Select","Select",""],["","143924920","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","69452014430","BENZONATATE","200MGCAPSULE","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}