{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dawn Stewart","gend":1,"add":"309 Chadwyck Circle","city":"Bonaire","state":"GA","zip":31005,"dob":"1962-03-30","age":"","mstatus":"","insh":4056660001,"cliId":"","pno":4783341588,"cno":"","email":"sdms62@aol.com","ename":"","eno":"","pphy":"MOUSA ALWAWI","ppno":"","pcpadd":"1601 Watson Boulevard,N","pcpcity":"Warner Robins","pcpstate":"GA","pcpzip":"","pcpcounty":"Warner Robins","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":["Z20.828","R07.9","R06.02","Z12.31","M25.511","R51","R90.89","I10","R53.1","R53.83","Z88.1","Z88.0","Z88.2","S83.281","M17.11","M94.261","M65.861","Z86.718","Z86.16","M13.80","R06.00","Z00.00","Z68.32","I50.1","I36.1","R03.0","R91.8","J98.11","S83.231","E11.9","E03.9","E78.5","Z79.899","E55.9","E53.8","R79.89","R94.31","U07.1","F39","Z86.73","I63.9","R09.89","M25.561","M62.81","Z12.11","M17.9","Z01.818","M25.572","R63.5","F33.1","I80.202","R05","I50.9","I42.9","M54.12","M77.42","M20.12","S83.241","Z48.89","M84.351","S83.242","M25.461"],"date":["2020-10-20","2021-01-06","2021-02-11","2021-01-06","2020-07-07","2020-09-01","2020-09-01","2022-01-06","2021-01-06","2021-07-06","2020-09-01","2020-09-01","2020-09-01","2021-05-11","2021-09-07","2021-05-04","2021-05-11","2021-05-04","2021-05-04","2022-01-06","2021-01-19","2020-11-03","2020-11-03","2020-10-27","2020-10-27","2021-01-06","2021-01-06","2021-01-06","2021-05-04","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-01-06","2021-01-12","2021-02-11","2020-12-08","2021-01-06","2020-12-01","2021-07-06","2021-06-15","2021-06-15","2021-03-02","2021-04-06","2021-04-27","2020-06-16","2022-01-06","2022-01-06","2021-07-06","2021-01-06","2020-12-15","2020-12-15","2020-09-29","2020-04-21","2020-04-21","2021-05-11","2021-07-13","2021-06-29","2021-12-08","2021-11-18"],"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":[["","54429731","FUROSEMIDE","20MGTABLET","30","Select","Select",""],["","69543013611","TRAMADOL","HCL50MGTABLET","25","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","65862020299","LOSARTAN","POTASSIUM50MGTAB","30","Select","Select",""],["","406012305","HYDROCODONE-ACETAMIN","5-325MG","25","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","68382032001","POTASSIUM","CLER10MEQTABLET","30","Select","Select",""],["","49483060450","IBUPROFEN","800MGTABLET","20","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","43547040011","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","406048410","ACETAMINOPHEN-COD","#3TABLET","25","Select","Select",""],["","70461032003","FLUCELVAX","QUAD2020-2021SYR","0.5","Select","Select",""],["","68180035202","SERTRALINE","HCL50MGTABLET","30","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","42571025201","CLINDAMYCIN","HCL300MGCAPSULE","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":""}]}]}