{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WANDA GRIFFIN","gend":1,"add":"112 Edwards St","city":"Moultrie","state":"GA","zip":31768,"dob":"1962-12-20","age":"","mstatus":"","insh":3769037001,"cliId":"","pno":2299212817,"cno":"","email":"wandacgriff62@gmail.com","ename":"","eno":"","pphy":" ","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","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":["K80.20","R07.89","M25.511","I10","Z09","Z20.822","R53.83","K81.0","K81.2","Z23","H25.812","H25.11","H40.033","R91.8","R07.9","K82.8","R10.11","K82.9","N39.0","K21.9","R11.2","R30.0","K81.9","R10.9"],"date":["2022-01-06","2021-11-02","2021-11-02","2021-11-23","2021-11-02","2022-01-06","2021-11-23","2022-01-06","2022-01-06","2021-09-01","2021-08-05","2021-05-11","2021-05-11","2021-10-20","2021-11-09","2022-01-06","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2022-01-06"],"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":[["","16714098801","ROSUVASTATIN","CALCIUM5MGTAB","30","Select","Select",""],["","65862035705","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","59762134401","PREGABALIN","50MGCAPSULE","90","Select","Select",""],["","68382002310","ATENOLOL","50MGTABLET","30","Select","Select",""],["","93206406","CILOSTAZOL","100MGTABLET","60","Select","Select",""],["","378021610","FUROSEMIDE","40MGTABLET","30","Select","Select",""],["","29033000305","SUCRALFATE","1GMTABLET","60","Select","Select",""],["","16714098001","ESOMEPRAZOLE","MAGDR40MGCAP","30","Select","Select",""],["","62332003231","ROPINIROLE","HCL1MGTABLET","30","Select","Select",""],["","24208060203","PROLENSA","0.0007EYEDROPS","3","Select","Select",""],["","832532510","POTASSIUM","CLER20MEQTABLET","60","Select","Select",""],["","68180096301","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","17478071310","OFLOXACIN","0.003EYEDROPS","5","Select","Select",""],["","60758011905","PREDNISOLONE","AC0.01EYEDROP","5","Select","Select",""],["","65862018601","CLINDAMYCIN","HCL300MGCAPSULE","6","Select","Select",""],["","406012301","HYDROCODONE-ACETAMIN","5-325MG","20","Select","Select",""],["","16714043901","NITROFURANTOIN","MONO-MCR100MG","14","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":""}]}]}