{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leah M Perry","gend":1,"add":"305 McConnell Rd","city":"Calhoun","state":"GA","zip":30701,"dob":"1980-06-20","age":"","mstatus":"","insh":3890707001,"cliId":"","pno":7069795926,"cno":"","email":"leperry491@gmail.com","ename":"","eno":"","pphy":"WILLIAM HAMILTON","ppno":"","pcpadd":"400 Timms Road NE,N","pcpcity":"Calhoun","pcpstate":"GA","pcpzip":"","pcpcounty":"Calhoun","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"Apt 7","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","R11.2","R42","J45.20","Z20.822","H66.003","Z68.24","R06.00","R19.7","U07.1","Z00.00","Z13.31","Z60.2","Z97.3","Z87.891","Z86.010","G47.09","G43.909","J45.909","F31.32","F43.10","K05.6","R05","G47.00","F41.1","J30.2","Z87.09","Z71.9","R50.9","M79.10","R06.02","J02.9","R11.10","R43.8"],"date":["2021-12-07","2021-12-07","2021-09-28","2021-12-07","2021-12-07","2021-10-12","2021-10-12","2021-09-21","2021-09-21","2021-09-21","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-09-21","2021-04-13","2021-04-13","2020-05-12","2020-05-12","2020-05-12","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21"],"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":[["","67877032105","IBUPROFEN","800MGTABLET","20","Select","Select",""],["","68180016013","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","69097012203","TOPIRAMATE","25MGTABLET","60","Select","Select",""],["","13668001005","CITALOPRAM","HBR20MGTABLET","30","Select","Select",""],["","50111043401","TRAZODONE","100MGTABLET","30","Select","Select",""],["","93083205","CLONAZEPAM","0.5MGTABLET","20","Select","Select",""],["","93310905","AMOXICILLIN","500MGCAPSULE","21","Select","Select",""],["","93742698","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","116200116","CHLORHEXIDINE","0.0012RINSE","473","Select","Select",""],["","603233832","ACETAMINOPHEN-COD","#3TABLET","8","Select","Select",""],["","24208063562","NEOMYCIN-POLYMYXIN-HC","EARSUSP","10","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMIN","5-325MG","12","Select","Select",""],["","64380071307","BENZONATATE","200MGCAPSULE","21","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","65862039010","ONDANSETRON","ODT4MGTABLET","15","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":""}]}]}