{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kim Miller","gend":1,"add":"484 Lower Dawnville Rd NE","city":"Dalton","state":"GA","zip":30721,"dob":"1962-09-19","age":"","mstatus":"","insh":3759276001,"cliId":"","pno":7062703822,"cno":"","email":"kimmil@windstream.net","ename":"","eno":"","pphy":"ALEJANDRA STAUBS","ppno":"","pcpadd":"3957 Cleveland Hwy Ste B","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":["I25.9","R00.2","E78.5","E03.9","S89.91X","S83.8X1","M79.651","R10.31","I10","M25.561","S83.421","R07.89","T14.90X","M54.59","M25.551","R73.03","E55.9","Z23","Z12.11","Z28.3","Z95.1","E07.9","E66.9","Z68.30","F17.210","Z79.82","I25.10","S83.241","M79.10","M54.16","M79.18","M54.17","S83.211","S83.511"],"date":["2021-03-30","2021-03-30","2021-11-09","2021-11-09","2021-03-23","2021-03-23","2021-02-23","2021-02-23","2021-09-14","2021-02-11","2021-04-20","2021-02-11","2021-02-11","2021-12-07","2021-10-26","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-20","2021-11-09","2021-12-07","2021-12-07","2021-11-09","2021-05-11","2021-03-30"],"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":[["","72205000499","ROSUVASTATIN","CALCIUM20MGTAB","30","Select","Select",""],["","68180098103","LISINOPRIL","20MGTABLET","30","Select","Select",""],["","52817033200","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","42858010401","OXYCODONE-ACETAMINOPHEN","10-325","56","Select","Select",""],["","16729045117","LEVOTHYROXINE","100MCGTABLET","30","Select","Select",""],["","16714066202","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","603459315","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","60432053716","NYSTATIN","100000UNIT\/MLSUSP","473","Select","Select",""],["","406048410","ACETAMINOPHEN-COD","#3TABLET","18","Select","Select",""],["","29300012510","MELOXICAM","15MGTABLET","30","Select","Select",""],["","406012301","HYDROCODONE-ACETAMIN","5-325MG","20","Select","Select",""],["","66993058597","FLUTICASONE-SALMETEROL","250-50","60","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":""}]}]}