{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carolyn Peacock","gend":1,"add":"545 Gregory St","city":"Vienna","state":"GA","zip":31092,"dob":"1959-06-28","age":"","mstatus":"","insh":3835207001,"cliId":"","pno":4782442561,"cno":"","email":"cpeacock901@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":["E04.1","I10","E11.9","Z80.0","Z86.73","C78.7","Z90.49","C18.9","C77.9","Z79.82","Z79.84","L40.50","Z20.822","Z92.21","D50.9","R11.2","R80.9","K76.9","E11.65","Z01.31","Z85.038","R53.1","C18.4","R11.0","K59.00","R79.89","E86.0","R26.9","I69.331","Z79.899","E11.22","N18.2","Z79.4","L40.0","R76.0","Z68.30","Z45.2","Z01.818","C79.51","J98.11","K76.89","E04.2"],"date":["2021-12-16","2021-12-16","2021-09-14","2021-12-16","2021-12-16","2021-11-30","2021-09-14","2021-09-22","2021-09-14","2021-12-08","2021-09-14","2021-10-26","2021-09-14","2021-09-14","2021-12-16","2021-12-08","2021-12-08","2021-12-08","2021-12-16","2021-09-02","2021-05-11","2021-07-20","2021-12-16","2021-12-16","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-14","2021-12-28","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-08-05","2021-10-06","2021-12-14","2021-06-15","2021-06-22","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":[["","23155000810","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","50742061510","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","64980028101","GLIPIZIDE","ER10MGTABLET","30","Select","Select",""],["","59746011506","PROCHLORPERAZINE","10MGTAB","30","Select","Select",""],["","74055402","HUMIRA(CF)","PEN40MG\/0.4ML","2","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMIN","5-325MG","14","Select","Select",""],["","70377002911","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","70377000415","SIMVASTATIN","40MGTABLET","30","Select","Select",""],["","68462010630","ONDANSETRON","HCL8MGTABLET","18","Select","Select",""],["","169185550","NOVOFINE","PLUSPENNDL32GX1\/6","100","Select","Select",""],["","66993068130","OLANZAPINE","5MGTABLET","6","Select","Select",""],["","68180051703","LISINOPRIL","40MGTABLET","30","Select","Select",""],["","68180072003","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","49281042150","FLUZONE","QUAD2021-2022SYRINGE","0.5","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}