{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tanya Smith","gend":1,"add":"3358 Guthrie Dr","city":"Macon","state":"GA","zip":31204,"dob":"1963-10-11","age":"","mstatus":"","insh":4048393001,"cliId":"","pno":4787458249,"cno":"","email":"aunttanya5@gmail.com","ename":"","eno":"","pphy":"SARAH MATOVU","ppno":"","pcpadd":"770 Walnut St","pcpcity":"Macon","pcpstate":"GA","pcpzip":"","pcpcounty":"Macon","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":["M54.30","E11.9","E78.5","Z79.4","R07.9","R05","H92.03","J02.9","S39.012","J06.9","Z20.828","M54.31"],"date":["2020-07-14","2020-12-15","2020-12-15","2020-11-10","2020-10-27","2020-10-27","2020-12-15","2020-12-15","2020-07-14","2020-11-10","2020-10-27","2020-02-11"],"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":[["","93727156","PIOGLITAZONE","HCL15MGTABLET","30","Select","Select",""],["","42571017701","PIROXICAM","20MGCAPSULE","30","Select","Select",""],["","2871501","HUMULIN","70-30VIAL","10","Select","Select",""],["","69238115403","EZETIMIBE","10MGTABLET","30","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","62175032046","NIACIN","ER500MGTABLET","30","Select","Select",""],["","42571016142","AMOX-CLAV","500-125MGTABLET","30","Select","Select",""],["","68645057390","GLIMEPIRIDE","4MGTABLET","30","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","68645056354","IBUPROFEN","800MGTABLET","90","Select","Select",""],["","93505798","ATORVASTATIN","80MGTABLET","30","Select","Select",""],["","68645054559","METFORMIN","HCL1000MGTABLET","60","Select","Select",""],["","93720210","PRAVASTATIN","SODIUM40MGTAB","30","Select","Select",""],["","70010010810","GABAPENTIN","100MGCAPSULE","90","Select","Select",""],["","68382014601","RAMIPRIL","5MGCAPSULE","30","Select","Select",""],["","68462029817","CLOTRIMAZOLE-BETAMETHASONE","CRM","30","Select","Select",""],["","51672129801","KETOCONAZOLE","0.02CREAM","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}