{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brian N Highsmith","gend":0,"add":"10559 Big cANOE","city":"jASPER","state":"GA","zip":30143,"dob":"1974-06-20","age":"","mstatus":"","insh":4041944001,"cliId":"","pno":7048076908,"cno":"","email":"brianhighsmith2@gmail.com","ename":"","eno":"","pphy":"JOHN MOULTRIE","ppno":"","pcpadd":"1255 Hwy 54 W","pcpcity":"Fayetteville","pcpstate":"GA","pcpzip":"","pcpcounty":"Fayetteville","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":["L03.221","F41.9","M10.9","G47.33","J45.909","I10","F17.210","Z79.899","E66.9","Z68.33","K11.5","J06.0","R22.1","D11.7","R49.0","Z00.00","Z23","J03.90","F10.10","Z72.0","Z12.11","Z12.12","F17.200","J34.2","R13.10","Z87.442","Z82.49","F32.9","A41.9","E66.8","Z01.818","L03.222","K11.21","K11.23","K11.8","E11.9","K75.81"],"date":["2020-09-22","2020-09-22","2020-09-22","2020-09-22","2020-11-03","2021-11-09","2020-11-03","2020-09-22","2020-09-22","2020-09-22","2020-09-08","2020-05-12","2020-11-03","2020-09-08","2020-05-12","2021-11-09","2021-11-09","2020-01-28","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2020-09-01","2020-09-08","2020-09-29","2020-09-29","2020-09-29","2020-11-03","2020-11-03"],"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":[["","406048401","ACETAMINOPHEN-COD","#3TABLET","15","Select","Select",""],["","65862018501","CLINDAMYCIN","HCL150MGCAPSULE","30","Select","Select",""],["","27241009990","DULOXETINE","HCLDR60MGCAP","30","Select","Select",""],["","378021810","ATENOLOL","25MGTABLET","30","Select","Select",""],["","16714047802","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","65162046650","IBUPROFEN","800MGTABLET","20","Select","Select",""],["","67877019905","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","70436001002","BUPROPION","HCLXL150MGTABLET","30","Select","Select",""],["","59746017509","PREDNISONE","20MGTABLET","5","Select","Select",""],["","406012405","HYDROCODONE-ACETAMIN","7.5-325","12","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","143928501","AMOXICILLIN","875MGTABLET","14","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","14","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":""}]}]}