{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John Jones","gend":0,"add":"704 Brookhaven Dr","city":"Chatsworth","state":"GA","zip":30705,"dob":"1971-09-18","age":"","mstatus":"","insh":3692681001,"cliId":"","pno":7622192968,"cno":"","email":"pullingteeth71@yahoo.com","ename":"","eno":"","pphy":"NATALIE BESSOM","ppno":"","pcpadd":"1012 Burleyson Rd","pcpcity":"Dalton","pcpstate":"GA","pcpzip":"","pcpcounty":"Dalton","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":["Z20.828","I10","K70.30","F41.9","N17.9","F17.210","E66.9","Z68.35","F10.21","E87.6","E83.42","E87.1","E11.65","D69.6","R79.1","Z96.649","G47.00","Z20.822","R20.0","R42","R05","E66.01","Z68.38","R20.2","R06.02","M13.851","M72.2","G47.09","F10.288","H81.13","F41.8","F12.10","R06.83","M16.11","Z96.641","H65.02","H60.92","R73.03","Z13.220","M10.09","M25.551","M19.90","I87.2","R07.9","R50.9","R19.7","R53.83","R52","F10.239","Z47.1","Z71.9","Z28.21","R00.0","B34.9","M62.830","R07.89","Z01.810"],"date":["2020-12-08","2021-12-28","2020-12-08","2020-12-08","2020-12-08","2021-07-13","2020-12-08","2020-12-08","2021-07-13","2021-07-20","2021-07-20","2021-07-13","2021-12-28","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-09-21","2021-07-13","2021-07-13","2021-09-21","2021-07-13","2021-07-13","2021-07-13","2021-09-21","2021-03-02","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-03-16","2021-03-16","2021-07-06","2021-07-06","2021-08-24","2021-04-27","2021-08-03","2021-03-02","2021-03-02","2021-03-02","2021-07-20","2021-09-21","2021-09-21","2021-09-28","2021-09-21","2020-11-10","2020-12-08","2020-11-03","2020-11-03","2021-06-15","2021-09-28","2021-03-30","2021-06-22","2020-12-08"],"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":[["","65162062750","TRAMADOL","HCL50MGTABLET","30","Select","Select",""],["","68382080701","TRAZODONE","150MGTABLET","30","Select","Select",""],["","68645051054","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","43598065530","BUPROPION","HCLXL150MGTABLET","30","Select","Select",""],["","68180044801","QUETIAPINE","FUMARATE200MGTAB","30","Select","Select",""],["","31722070290","LOSARTAN","POTASSIUM100MGTAB","30","Select","Select",""],["","68645058054","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","68645058459","METFORMIN","HCL1000MGTABLET","60","Select","Select",""],["","406012301","HYDROCODONE-ACETAMIN","5-325MG","28","Select","Select",""],["","67877022310","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","61314064511","NEOMYCIN-POLYMYXIN-HC","EARSUSP","10","Select","Select",""],["","68180071160","CEFDINIR","300MGCAPSULE","14","Select","Select",""],["","47781060730","DISULFIRAM","250MGTABLET","30","Select","Select",""],["","60505009500","DOXAZOSIN","MESYLATE4MGTAB","60","Select","Select",""],["","54001925","PREDNISONE","50MGTABLET","5","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","186037020","SYMBICORT","160-4.5MCGINHALER","10.2","Select","Select",""],["","16714003902","COLCHICINE","0.6MGTABLET","3","Select","Select",""],["","76385011250","CARVEDILOL","12.5MGTABLET","60","Select","Select",""],["","49281042050","FLUZONE","QUAD2020-2021SYRINGE","0.5","Select","Select",""],["","93101042","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","143928501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","10702000709","CYCLOBENZAPRINE","10MGTABLET","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":["",""],"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":""}]}]}