{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michelle W Folks","gend":1,"add":"376 Hidden Valley Rd","city":"La Fayette","state":"GA","zip":30728,"dob":"1964-12-16","age":"","mstatus":"","insh":3806342001,"cliId":"","pno":4239030694,"cno":"","email":"michelle@telemetricscorp.com","ename":"","eno":"","pphy":"Mark Cloutier","ppno":"","pcpadd":"1809 Gunbarrel Road,Suite 10","pcpcity":"Chattanooga","pcpstate":"TN","pcpzip":"","pcpcounty":"Chattanooga","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":["K21.9","K76.0","R92.8","D48.61","M76.822","M19.079","M25.871","M25.872","M21.961","M21.962","N64.59","K82.4","R30.0","Z87.442","Z13.820","Z78.0","Z12.31","M85.89","M62.838","M19.072","L90.5","D48.5","M17.11","M76.821","M17.0","G57.01","R20.0","R20.2","C44.619","C44.719","C44.712","C44.41","L81.4","D21.22","D21.11","D21.21","L73.8","Z85.820","Z12.83","R31.9","M54.5","Z68.33","S19.9XX","S39.81X","I70.0","M25.561","M25.571","M25.562","M25.572","N63.12","S09.90X","S09.93X","R53.83","Z13.6","M21.42","M21.41","Z30.09","H40.012","H40.111","H40.221","Z96.1","R51.9","M79.644","D24.1","Q74.0","M81.0","L30.9","D22.9","Z01.419","Z13.21"],"date":["2022-01-04","2022-01-04","2021-02-11","2021-02-11","2021-08-31","2021-06-15","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-06-22","2021-11-30","2021-07-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-12-28","2021-06-22","2021-09-21","2021-08-31","2021-12-28","2021-08-31","2021-08-31","2021-12-28","2021-12-28","2021-12-28","2021-11-23","2021-11-23","2021-09-21","2021-10-12","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-07-27","2021-07-27","2021-07-27","2022-01-06","2022-01-06","2022-01-06","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-04-27","2022-01-06","2022-01-06","2021-12-28","2021-12-28","2021-05-04","2021-05-04","2021-07-20","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2022-01-06","2022-01-06","2021-03-02","2022-01-04","2021-02-09","2021-02-23","2021-02-23","2021-02-02","2021-02-09"],"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":[["","52817033010","CYCLOBENZAPRINE","5MGTABLET","15","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","781285931","OMEPRAZOLE","DR10MGCAPSULE","30","Select","Select",""],["","93506105","HYDROXYZINE","HCL25MGTABLET","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","20","Select","Select",""],["","47781030301","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","69584061150","METHOCARBAMOL","500MGTABLET","20","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":""}]}]}