{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENNIS M TAYLOR","gend":0,"add":"111 Cooley Woods Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"1962-11-24","age":"","mstatus":"","insh":3702999002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"BRADLEY PIERCE","ppno":"","pcpadd":"743 Spring Street NE","pcpcity":"Gainesville","pcpstate":"GA","pcpzip":"","pcpcounty":"Gainesville","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":["E11.341","I65.23","H25.043","H25.13","H04.123","H11.153","E11.65","Z79.4","E78.2","E29.1","Z00.00","E11.9","R79.89","I10","E55.9","M25.562","H90.0","Z86.73","M54.2","L30.9","M72.0","R53.82","Z68.33","H35.053","E11.339","E10.331","E11.331","E03.9","R63.8","R31.9","H25.12","N40.0","N52.9","Z23","M75.02","E11.321","H52.7","Z68.32","I63.50","Z12.11"],"date":["2021-03-30","2021-03-30","2021-02-11","2021-11-16","2021-02-11","2021-02-11","2021-11-09","2021-11-23","2021-11-09","2021-11-02","2021-03-30","2020-12-08","2021-11-02","2021-11-02","2021-06-22","2021-11-02","2021-11-02","2020-05-26","2021-06-22","2020-09-01","2021-11-02","2021-11-02","2021-07-06","2021-06-08","2021-06-08","2020-09-01","2021-11-30","2021-11-09","2021-11-02","2021-11-09","2022-01-04","2021-11-02","2021-07-06","2020-12-08","2021-06-22","2021-02-11","2021-12-28","2020-02-18","2020-02-18","2020-02-18"],"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":[["","60505317007","OMEGA-3","ETHYLESTERS1GMCAP","120","Select","Select",""],["","60505025303","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","88222033","LANTUS","100UNIT\/MLVIAL","10","Select","Select",""],["","68645055854","LISINOPRIL-HCTZ","20-25MGTAB","30","Select","Select",""],["","68645049554","ATORVASTATIN","80MGTABLET","30","Select","Select",""],["","68645054459","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","72305002530","EUTHYROX","25MCGTABLET","30","Select","Select",""],["","42806054701","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","61314062810","POLYMYXIN","B-TMPEYEDROPS","10","Select","Select",""],["","67877045005","TAMSULOSIN","HCL0.4MGCAPSULE","30","Select","Select",""],["","2751001","HUMALOG","100UNIT\/MLVIAL","10","Select","Select",""],["","67877019705","AMLODIPINE","BESYLATE2.5MGTAB","30","Select","Select",""],["","574082001","TESTOSTERONE","CYP200MG\/ML","2","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":""}]}]}