{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jerome Jones","gend":0,"add":"809 North Fourth Ave","city":"Chatsworth","state":"GA","zip":30705,"dob":"1962-05-24","age":"","mstatus":"","insh":3647583001,"cliId":"","pno":7062808163,"cno":"","email":"jeromejones5062@gmail.com","ename":"","eno":"","pphy":"JAMES BROWN","ppno":"","pcpadd":"320 Market St","pcpcity":"Chatsworth","pcpstate":"GA","pcpzip":"","pcpcounty":"Chatsworth","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":["Z00.00","I11.9","I25.10","Z13.31","Z12.11","Z23","J43.8","R73.9","R53.83","L72.3","Z78.9","L02.811","L53.9","K57.30","K64.4","I25.2","I10","F17.200","Z79.899","Z79.82","Z80.8","Z82.49","J30.1"],"date":["2022-01-04","2021-09-14","2021-09-14","2022-01-04","2020-03-31","2021-12-28","2020-06-16","2020-06-16","2021-09-14","2020-11-03","2020-11-03","2020-10-27","2020-10-27","2020-03-31","2020-03-31","2020-03-24","2020-03-24","2020-03-24","2020-03-24","2020-03-24","2020-03-24","2020-03-24","2020-05-26"],"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":[["","378363105","CARVEDILOL","3.125MGTABLET","60","Select","Select",""],["","27808015701","ROSUVASTATIN","CALCIUM20MGTAB","30","Select","Select",""],["","43547035150","LISINOPRIL","2.5MGTABLET","30","Select","Select",""],["","60505083305","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","65862035705","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","43386006019","GAVILYTE-C","SOLUTION","4000","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","14","Select","Select",""],["","68462018801","NAPROXEN","250MGTABLET","21","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":""}]}]}