{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mitch K Vance","gend":0,"add":"708 Davenport Rd","city":"Dalton","state":"GA","zip":30721,"dob":"1982-03-19","age":"","mstatus":"","insh":3898442001,"cliId":"","pno":7622010930,"cno":"","email":"mitchellvance149@gmail.com","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":["R30.0","R52","Z72.51","R07.2","R55","R00.2","I10","R56.9","R20.2","Z20.822","U07.1","R05","I42.8","I47.1","E78.5","R29.818","N20.0","Z01.818","I20.9","R94.39","F17.210","F41.1","R07.89","R59.9","F41.9","F20.0","F31.89","R47.82","M79.644","K14.8","F19.959","R29.90","F31.9","Z46.9"],"date":["2022-01-04","2022-01-04","2022-01-04","2021-11-23","2021-11-30","2021-12-07","2021-12-21","2021-11-02","2021-11-30","2021-11-23","2021-09-07","2021-09-07","2022-01-04","2021-12-21","2021-12-21","2021-11-23","2021-12-28","2021-11-23","2022-01-04","2022-01-04","2022-01-04","2021-11-16","2021-11-09","2022-01-04","2021-11-30","2021-11-30","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2022-01-04","2021-11-09","2021-10-26","2021-11-09"],"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":[["","536123441","ASPIRIN","EC81MGTABLET","30","Select","Select",""],["","68382013210","TAMSULOSIN","HCL0.4MGCAPSULE","30","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","68382013510","LOSARTAN","POTASSIUM25MGTAB","30","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MGTABLET","90","Select","Select",""],["","50816002503","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","172392670","DIAZEPAM","5MGTABLET","90","Select","Select",""],["","13107008405","LORAZEPAM","1MGTABLET","56","Select","Select",""],["","78065920","ENTRESTO","24MG-26MGTABLET","60","Select","Select",""],["","52817018000","CLONIDINE","HCL0.1MGTABLET","30","Select","Select",""],["","68180063509","ATORVASTATIN","10MGTABLET","30","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","7","Select","Select",""],["","52427066730","LOREEV","XR3MGCAPSULE","30","Select","Select",""],["","93227534","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","69543038030","OLANZAPINE","2.5MGTABLET","30","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":""}]}]}