{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Renee Eskew","gend":1,"add":"1194 Knight Rd","city":"Rockmart","state":"GA","zip":30153,"dob":"1965-10-11","age":"","mstatus":"","insh":3976223001,"cliId":"","pno":7708707752,"cno":"","email":"Reskewquilts1@aol.com","ename":"","eno":"","pphy":"Julaine Cross","ppno":"","pcpadd":"11766 Hwy 27 N","pcpcity":"Summerville","pcpstate":"GA","pcpzip":"","pcpcounty":"Summerville","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":["Z00.00","E03.9","R53.83","F32.9","C50.919","M25.50","R73.09","E78.2","Z12.11","Z68.30","J45.909","M17.10","E78.5","E66.9","Z79.890","Z68.32","Z93.3","Z98.0","Z20.828","D64.9","Z11.52","Z20.822","A08.4","R10.9","J06.9","B97.89","J45.21","R05","J02.9","J01.00","K57.90","K57.30","L71.8"],"date":["2020-06-23","2021-01-05","2020-06-02","2021-01-26","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2021-01-26","2020-06-02","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2020-12-08","2020-06-02","2021-08-24","2021-08-31","2021-08-31","2021-01-19","2021-06-15","2021-06-15","2021-06-15","2021-10-12","2021-10-12","2021-10-12","2020-12-01","2021-01-26","2020-08-18"],"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":[["","65862017760","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","76204020060","ALBUTEROL","SUL2.5MG\/3MLSOLN","360","Select","Select",""],["","591405289","IVERMECTIN","0.01CREAM","45","Select","Select",""],["","69238183107","LEVOTHYROXINE","50MCGTABLET","30","Select","Select",""],["","65862007701","CIPROFLOXACIN","HCL500MGTAB","20","Select","Select",""],["","603533815","PREDNISONE","10MGTABDOSEPACK","21","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","120","Select","Select",""],["","65862064130","AZITHROMYCIN","250MGTABLET","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":""}]}]}