{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cynthia L French","gend":1,"add":"98 Macedonia Church Rd","city":"Blue Ridge","state":"GA","zip":30513,"dob":"1960-05-09","age":"","mstatus":"","insh":4096492001,"cliId":"","pno":7064552525,"cno":"","email":"Cindydeanfrench@icloud.com","ename":"","eno":"","pphy":"Neal Tah","ppno":"","pcpadd":"4799 Blue Ridge Drive,Suite 10","pcpcity":"Blue Ridge","pcpstate":"GA","pcpzip":"","pcpcounty":"Blue Ridge","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":["I10","E83.42","E83.51","R79.89","D53.9","L72.0","M06.9","F17.210","Z87.19","D50.9","R79.9","E55.9","R53.83","E56.9","E78.5","R00.8","E03.9","D75.89","R79.0","M10.9","J30.2","G47.00","R40.0","I48.20","R94.6","Z23","R74.8","N28.9","R89.9","Z01.810","R56.9","R41.82","I48.0","E78.2","F17.200","Z72.89","F10.239","I48.91","A04.72","E87.1","F51.09","J30.9","R77.8","R74.01","R94.4","R94.5","M25.461","G93.41","N17.9","G40.89","E86.0","E83.39","F10.232","E87.6","N18.3","D64.9","I12.9","K21.9","Z96.1","Z78.1","Z79.899","Z88.2","Z11.59","E56.8","R39.2","J20.9","J06.9","F41.9","F41.1","D23.22","R05","R51.9","R19.7","I34.0","I35.1","I36.1","D48.5","R94.31","M54.5","M15.0","J32.9","J30.89","Z76.89"],"date":["2021-12-28","2021-11-02","2021-09-14","2021-09-14","2021-11-02","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2020-11-24","2020-09-29","2021-08-10","2020-09-29","2021-08-05","2021-05-04","2021-05-04","2021-08-05","2021-05-04","2021-05-04","2021-08-05","2021-08-05","2021-08-05","2021-05-04","2021-11-02","2021-08-10","2021-04-20","2020-12-01","2020-11-17","2020-11-03","2020-09-22","2020-06-09","2020-06-09","2021-12-28","2021-12-28","2021-12-28","2020-05-26","2020-05-26","2021-08-24","2020-08-11","2021-06-01","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2020-11-10","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2021-08-24","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2021-06-29","2020-09-29","2020-07-07","2021-09-02","2021-07-20","2020-06-16","2020-09-29","2021-06-29","2021-01-26","2021-01-26","2021-01-26","2020-06-02","2020-06-02","2020-06-02","2021-07-13","2021-07-27","2020-02-11","2020-02-11","2020-02-11","2021-08-05","2021-06-08"],"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","20","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","70377000215","SIMVASTATIN","10MGTABLET","30","Select","Select",""],["","93321205","CLONAZEPAM","1MGTABLET","30","Select","Select",""],["","68001015403","CARVEDILOL","6.25MGTABLET","60","Select","Select",""],["","60505083001","MOMETASONE","FUROATE50MCGSPRY","17","Select","Select",""],["","65862064163","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","50458057930","XARELTO","20MGTABLET","30","Select","Select",""],["","68001035600","METOPROLOL","SUCCER25MGTAB","60","Select","Select",""],["","24979002607","DILTIAZEM","24HER(CD)120MGCP","30","Select","Select",""],["","781518110","LEVOTHYROXINE","50MCGTABLET","30","Select","Select",""],["","29300034901","ALLOPURINOL","100MGTABLET","30","Select","Select",""],["","93314705","CEPHALEXIN","500MGCAPSULE","28","Select","Select",""],["","68382080505","TRAZODONE","50MGTABLET","30","Select","Select",""],["","80777027310","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","64380080707","IBUPROFEN","800MGTABLET","90","Select","Select",""],["","68180016613","VANCOMYCIN","HCL125MGCAPSULE","32","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","68001000501","METHYLPREDNISOLONE","4MGDOSEPK","21","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":""}]}]}