{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Terry Bell","gend":0,"add":"301 COPS RD","city":"BLUE RIDGE","state":"GA","zip":30513,"dob":"1962-05-05","age":"","mstatus":"","insh":3929112001,"cliId":"","pno":7064554300,"cno":"","email":"tsc@tds.net","ename":"","eno":"","pphy":"THOMAS GARY","ppno":"","pcpadd":"346 Deep South Farm Rd,Suite ","pcpcity":"Blairsville","pcpstate":"GA","pcpzip":"","pcpcounty":"Blairsville","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":["C18.0","K57.30","Z86.010","E78.5","I10","Z87.891","Z79.82","Z82.3","Z83.3","Z82.49","E78.2","R73.09","Z79.899","N40.0","M54.5","M25.522","Z00.00","R21","R97.20","N28.1","R35.1","Z12.5","M72.2","M79.671","M24.572","M24.571","M20.12","M20.11","M21.6X9","Z12.11","R73.03","F51.01","M25.512","M54.50","N28.9","K40.90","D12.8","D41.4","Z95.1","C18.2","D12.0","I25.10","Z68.26","R00.2","N52.9","R93.41","N40.1","Z00.01","G89.29","Z13.29","N28.89","Z85.038","Z90.49","Z83.49","Z11.52","H66.001","H65.02","H93.13","Z01.818"],"date":["2020-04-09","2021-05-04","2020-02-11","2020-03-24","2021-12-16","2020-03-24","2020-03-24","2021-05-04","2020-03-17","2021-05-04","2021-12-16","2021-12-08","2021-12-16","2020-12-08","2021-05-25","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2021-05-04","2020-09-15","2020-12-08","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-01-28","2021-05-04","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2020-03-24","2020-03-24","2020-03-24","2020-03-24","2020-03-24","2020-03-03","2020-04-09","2021-07-06","2021-07-06","2020-06-16","2021-07-06","2020-02-25","2021-05-04","2021-06-01","2021-05-25","2021-05-25","2020-08-25","2021-05-04","2021-05-04","2021-05-04","2021-12-07","2021-07-27","2021-07-27","2021-07-27","2020-03-03"],"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":[["","70377003012","ATORVASTATIN","80MGTABLET","20","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMIN","5-325MG","15","Select","Select",""],["","59779027408","CVS","ASPIRIN81MGCHEWABLETAB","30","Select","Select",""],["","50742061510","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","93117701","NEOMYCIN","500MGTABLET","6","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","6","Select","Select",""],["","45802025742","MOMETASONE","FUROATE0.001CREAM","45","Select","Select",""],["","50111056001","TRAZODONE","50MGTABLET","30","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","69238148501","ERYTHROMYCIN","500MGFILMTAB","6","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":""}]}]}