{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tina Buford","gend":1,"add":"176 Ten Knolls Dr","city":"Macon","state":"GA","zip":31210,"dob":"1957-01-16","age":"","mstatus":"","insh":3710595001,"cliId":"","pno":4784615415,"cno":"","email":"tina.buford@yahoo.com","ename":"","eno":"","pphy":"Krishma Patel","ppno":"","pcpadd":"3400 Riverside Dr","pcpcity":"Macon","pcpstate":"GA","pcpzip":"","pcpcounty":"Macon","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":["H25.13","H11.153","E03.9","E11.9","J12.82","J93.9","J90","J96.01","Z68.41","E66.01","R33.9","Z79.82","Z85.850","Z45.2","J96.00","N39.0","U07.1","E05.90","R91.8","Z66","N17.9","I95.9","Z88.8","R41.82","Z99.11","Z99.81","J80","E78.5","J44.9","N20.0","R68.89","R31.0","I78.1","L82.0","Z46.59","R06.02","Z46.82","M62.81","N20.1"],"date":["2021-02-11","2021-02-11","2021-11-02","2021-11-02","2021-12-08","2021-12-08","2021-08-24","2021-12-08","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-23","2021-11-23","2021-05-04","2021-10-26","2021-09-28","2021-11-23","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-08-10","2021-08-24","2021-08-10","2021-12-08","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-05-25","2021-05-25","2021-09-01","2021-09-07","2021-11-09","2021-08-10","2021-05-04"],"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":[["","13668001105","CITALOPRAM","HBR40MGTABLET","30","Select","Select",""],["","76204020025","ALBUTEROL","SUL2.5MG\/3MLSOLN","75","Select","Select",""],["","173088710","TRELEGY","ELLIPTA100-62.5-25","60","Select","Select",""],["","55111046605","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","781185220","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","10","Select","Select",""],["","70436001006","BUPROPION","HCLXL150MGTABLET","30","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","68382013210","TAMSULOSIN","HCL0.4MGCAPSULE","30","Select","Select",""],["","76204060012","IPRAT-ALBUT","0.5-3(2.5)MG\/3ML","180","Select","Select",""],["","59746000106","METHYLPREDNISOLONE","4MGTABLET","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":""}]}]}