{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Heather Pyles","gend":1,"add":"2602 Lakeview Dr NW","city":"Rome","state":"GA","zip":30165,"dob":"1975-11-15","age":"","mstatus":"","insh":4054271001,"cliId":"","pno":7066688525,"cno":"","email":"pylesheather1975@gmail.com","ename":"","eno":"","pphy":"Randolph Sumner","ppno":"","pcpadd":"150 Gentilly Blvd","pcpcity":"Cartersville","pcpstate":"GA","pcpzip":"","pcpcounty":"Cartersville","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":["K80.20","M79.7","F41.9","E03.9","F17.210","Z20.822","R11.2","R19.7","S61.512","F17.200","G43.909","K81.0","S61.412","S51.812","M54.5","D72.829","R53.83","R10.11","Z68.28","Z20.828","F41.1","R53.81","J01.80","K80.00","K81.1","Z01.812"],"date":["2021-04-06","2021-09-07","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-05-18","2021-04-27","2021-04-27","2021-03-02","2021-08-05","2021-08-05","2021-11-09","2021-02-23","2021-02-23","2021-03-23","2021-09-07","2021-08-05","2021-09-07","2021-09-07","2021-08-05","2021-02-23","2021-03-09","2021-03-02"],"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":[["","55111012705","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","527128201","DICYCLOMINE","20MGTABLET","120","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MGTABLET","60","Select","Select",""],["","65862018830","ONDANSETRON","HCL8MGTABLET","24","Select","Select",""],["","68382004101","PROMETHAZINE","25MGTABLET","5","Select","Select",""],["","68382009810","PAROXETINE","HCL20MGTABLET","30","Select","Select",""],["","27808003503","HYDROCODONE-ACETAMIN","5-325MG","18","Select","Select",""],["","57237002901","AMOXICILLIN","875MGTABLET","14","Select","Select",""],["","70010077001","METHOCARBAMOL","750MGTABLET","30","Select","Select",""],["","245003623","PREVALITE","POWDER","231","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":""}]}]}