{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Abbey Merz","gend":1,"add":"4413 Nohl Crest Ln","city":"Flowery Branch","state":"GA","zip":30542,"dob":"1986-01-20","age":"","mstatus":"","insh":4097509002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Jack Cheng","ppno":"","pcpadd":"5875 Thompson Mill Rd,Suite 10","pcpcity":"Hoschton","pcpstate":"GA","pcpzip":"","pcpcounty":"Hoschton","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":["R59.1","R59.0","F41.9","Z23","E53.8","W57.XXX","F32.9","Z68.32","J45.909","Z85.41","N18.9","Z87.891","L30.8","L95.8","R55","Z20.822","Z79.890","E87.1","A69.20","H81.399","D72.823","F90.1","E66.9","Z68.33","R42","B00.0","B95.61","R59.9","R63.8","Z86.59","R63.5","E55.9","R79.89","L03.114","R21","R00.0","R29.898","Z91.040","Z88.5","Z88.1","Z88.8","G47.00","H81.392","R22.1","E03.9","R06.00","U07.1","Z20.828","Z03.818","R07.9","R83.6","C53.9","S00.06X","R20.8","H74.8X2","L98.6","L25.5","L23.89"],"date":["2022-01-06","2022-01-06","2021-10-12","2021-10-12","2021-11-02","2021-12-16","2021-10-12","2021-10-12","2021-11-02","2021-12-28","2021-09-28","2021-11-02","2021-10-26","2021-10-26","2021-10-19","2021-12-16","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-12-16","2021-11-02","2021-11-02","2021-12-28","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-11-09","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-09-28","2021-10-26","2021-12-08","2021-12-16","2021-05-25","2021-06-15","2021-06-08","2021-06-08","2021-12-16","2021-11-09","2021-12-16","2021-12-16","2021-12-16","2021-09-28","2021-12-16","2021-12-16","2021-12-16"],"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":[["","49483060701","GABAPENTIN","400MGCAPSULE","90","Select","Select",""],["","172392560","DIAZEPAM","2MGTABLET","14","Select","Select",""],["","11534016503","FOLIC","ACID1MGTABLET","30","Select","Select",""],["","527551537","DEXTROAMP-AMPHET","ER30MGCAP","30","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","8","Select","Select",""],["","68462011944","FLUCONAZOLE","150MGTABLET","3","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","168014630","HYDROCORTISONE","0.025OINTMENT","28.3","Select","Select",""],["","69097083302","SERTRALINE","HCL25MGTABLET","30","Select","Select",""],["","65862018730","ONDANSETRON","HCL4MGTABLET","12","Select","Select",""],["","70700010915","CLOBETASOL","0.0005CREAM","30","Select","Select",""],["","67877021905","CEPHALEXIN","500MGCAPSULE","15","Select","Select",""],["","65862052730","VENLAFAXINE","HCLER37.5MGCAP","30","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","781185220","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","555088704","ESTRADIOL","2MGTABLET","30","Select","Select",""],["","254100752","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","45802058084","SCOPOLAMINE","1MG\/3DAYPATCH","1","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MGTABLET","30","Select","Select",""],["","57664037718","TRAMADOL","HCL50MGTABLET","30","Select","Select",""],["","68382024701","BENZONATATE","100MGCAPSULE","21","Select","Select",""],["","42192033001","NP","THYROID60MGTABLET","30","Select","Select",""],["","68382013905","TOPIRAMATE","50MGTABLET","60","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":""}]}]}