{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIA P TURCIOS","gend":1,"add":"1182 VILLA CLARA","city":"GAINESVILLE","state":"GA","zip":30504,"dob":"1972-08-01","age":"","mstatus":"","insh":4096598001,"cliId":"","pno":6788986516,"cno":"","email":"maria1182turcios@gmail.com","ename":"","eno":"","pphy":"MARIA ALBAN","ppno":"","pcpadd":"2700 Clairmont Road NE","pcpcity":"Atlanta","pcpstate":"GA","pcpzip":"","pcpcounty":"Atlanta","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":["Z00.00","E55.9","Z12.39","Z68.30","Z11.4","Z11.59","Z28.3","I10","R73.03","R05","D64.9","R79.89","Z20.828","Z12.4","Z11.3","L30.8","L21.8","J02.9","J02.0","R50.9","R51.9","E11.9","Z68.31","M25.561","M25.562","G89.29","Z01.411","N76.0","B96.89","Z01.419","M17.0","J00","R06.82"],"date":["2021-07-13","2021-07-13","2021-07-06","2021-07-13","2021-07-13","2021-07-13","2021-07-06","2021-11-09","2021-08-03","2021-09-28","2021-11-09","2021-08-03","2021-10-06","2021-05-04","2021-05-04","2021-06-22","2021-06-22","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-11-09","2021-11-09","2021-03-02","2021-03-02","2021-03-02","2021-05-04","2021-05-04","2021-05-04","2021-04-27","2021-12-28","2021-08-10","2021-08-10"],"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":[["","65162019050","NAPROXEN","500MGTABLET","60","Select","Select",""],["","45802046564","KETOCONAZOLE","0.02SHAMPOO","120","Select","Select",""],["","51672135708","FLUOCINOLONE","0.0001SCALPOIL","118.2","Select","Select",""],["","68180098003","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","43386009662","CLOBETASOL","0.0005OINTMENT","60","Select","Select",""],["","50111033401","METRONIDAZOLE","500MGTABLET","14","Select","Select",""],["","69097084615","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","66993089749","BETAMETHASONE","DPAUG0.0005OIN","50","Select","Select",""],["","70010049110","METFORMIN","HCLER500MGTABLET","30","Select","Select",""],["","67877032105","IBUPROFEN","800MGTABLET","30","Select","Select",""],["","67877057305","BENZONATATE","100MGCAPSULE","9","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","20","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":""}]}]}