{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sylvia M Gentry","gend":1,"add":"2998 Rebecca Cir","city":"Rocky Face","state":"GA","zip":30740,"dob":"1960-02-15","age":"","mstatus":"","insh":3714743001,"cliId":"","pno":7065164104,"cno":"","email":"maybellgentry0215@gmail.com","ename":"","eno":"","pphy":"CHRISTOPHER YAMAMOTO","ppno":"","pcpadd":"109 Hospital Drive,N","pcpcity":"Calhoun","pcpstate":"GA","pcpzip":"","pcpcounty":"Calhoun","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":["J06.9","R11.0","R51","M54.2","R09.81","J30.2","J12.89","R50.9","I10","U07.1","R05","R06.02","R53.83","R11.2","R19.7","M79.10","Z20.828","Z71.89","E03.9","M65.30","Z68.27","R43.0","K29.70","E89.41","M65.311","S09.90X","Z00.00","K21.9","J45.909","F41.9","M79.641","R05.9","Z68.30","J98.01","R94.2","R06.2","R06.09","S00.83X","J30.1"],"date":["2020-02-11","2021-11-02","2020-02-11","2020-02-11","2020-02-11","2021-02-11","2021-01-05","2021-11-02","2020-12-22","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-11-02","2021-06-08","2021-04-20","2021-04-20","2021-04-20","2021-01-26","2021-01-26","2021-05-11","2021-05-11","2020-01-21","2020-01-21","2020-01-21","2020-01-21","2020-01-21","2020-10-06","2021-11-02","2021-11-02","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-02-11","2020-02-11"],"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":[["","31722070290","LOSARTAN","POTASSIUM100MGTAB","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA90MCGINHALER","18","Select","Select",""],["","43547028210","ESCITALOPRAM","20MGTABLET","30","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","68462019005","NAPROXEN","500MGTABLET","60","Select","Select",""],["","85113204","PROVENTIL","HFA90MCGINHALER","6.7","Select","Select",""],["","186037020","SYMBICORT","160-4.5MCGINHALER","10.2","Select","Select",""],["","65862039110","ONDANSETRON","ODT8MGTABLET","20","Select","Select",""],["","43547035510","LISINOPRIL","30MGTABLET","30","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","120","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":""}]}]}