{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda Edmonds","gend":1,"add":"2051 Crow Rd","city":"Gainesville","state":"GA","zip":30501,"dob":"1957-05-11","age":"","mstatus":"","insh":3915520001,"cliId":"","pno":6782830618,"cno":"","email":"hledmonds143@gmail.com","ename":"","eno":"","pphy":"Linu Joseph","ppno":"","pcpadd":"2578 Helen Hwy","pcpcity":"Cleveland","pcpstate":"GA","pcpzip":"","pcpcounty":"Cleveland","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":["S70.12X","Z68.25","S30.0XX","R26.89","R29.898","M62.81","M79.652","U07.1","H02.88A","H02.88B","H52.4","Z96.1","J01.00","Z68.27","T63.461","R03.0","E78.00","R73.9","W08.XXX","H25.811","H25.812","R09.81","H25.11","R53.83","Z76.89","J30.1","R45.89","Z12.31","Z12.11","Z68.26","H25.12","Z00.00","Z23","Z11.59","S79.922"],"date":["2021-12-07","2021-08-10","2021-12-07","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-10-05","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-12-28","2021-12-28","2021-08-31","2021-09-14","2021-07-06","2021-07-06","2021-07-06","2021-03-30","2021-04-13","2021-10-05","2021-04-27","2021-04-13","2021-03-09","2021-04-13","2021-03-09","2021-04-13","2021-04-13","2021-10-05","2021-04-27","2021-06-22","2021-12-21","2021-06-22","2021-06-29"],"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":[["","61314063705","PREDNISOLONE","AC0.01EYEDROP","5","Select","Select",""],["","17478020910","KETOROLAC","0.005OPHTHSOLUTION","5","Select","Select",""],["","61314062810","POLYMYXIN","B-TMPEYEDROPS","10","Select","Select",""],["","49281072110","FLUBLOK","QUAD2021-2022SYRINGE","0.5","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","58160082311","SHINGRIX","VIALKIT","1","Select","Select",""],["","93227534","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","61442010201","DICLOFENAC","SODDR50MGTAB","20","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","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":""}]}]}