{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Saida Rey","gend":1,"add":"206 Demorest Apartment Ct","city":"Demorest","state":"GA","zip":30535,"dob":"1960-08-24","age":"","mstatus":"","insh":4112333001,"cliId":"","pno":7068091320,"cno":"","email":"reysaida@yahoo.com","ename":"","eno":"","pphy":"JULIE WILLINGHAM","ppno":"","pcpadd":"800 Austin Dr","pcpcity":"Demorest","pcpstate":"GA","pcpzip":"","pcpcounty":"Demorest","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"Apt.308","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":["R07.89","R10.13","R10.11","R53.83","I10","K59.09","B37.89","Z00.00","K80.12","R10.12","M54.5","D72.829","R30.0","R35.0","N39.0","R03.1","R07.9","K81.0","R10.2","N28.1","Z12.31","R10.30","R07.81","R10.9","Z90.49","K21.9","R73.09","R10.10","K80.20","R14.0","R91.8","L50.0","Z71.3","N30.00","M85.80","N39.498","M79.642","Z78.0","Z86.11","K80.13"],"date":["2021-06-01","2021-06-08","2021-06-08","2021-06-08","2021-10-05","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-07-27","2021-07-27","2021-10-13","2021-10-13","2021-10-13","2021-07-13","2021-05-04","2021-05-04","2021-05-04","2021-06-08","2021-10-13","2021-05-25","2021-10-13","2021-07-13","2021-06-22","2021-06-22","2021-06-08","2021-05-25","2021-04-20","2021-04-20","2021-10-05","2021-04-20","2021-09-28","2021-06-08","2021-08-10","2021-08-10","2021-06-08","2021-06-08","2021-06-22","2021-10-13","2021-06-01"],"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":[["","16571020150","DICLOFENAC","SODEC75MGTAB","28","Select","Select",""],["","50111033402","METRONIDAZOLE","500MGTABLET","10","Select","Select",""],["","527512170","NYSTATIN","100000UNIT\/MLSUSP","473","Select","Select",""],["","31722071390","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","45802006335","TRIAMCINOLONE","0.00025CREAM","15","Select","Select",""],["","65862018730","ONDANSETRON","HCL4MGTABLET","24","Select","Select",""],["","65162047810","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","20","Select","Select",""],["","64380090603","CLARITHROMYCIN","500MGTABLET","10","Select","Select",""],["","47781019601","OXYCODONE-ACETAMINOPHEN","5-325","20","Select","Select",""],["","143924920","AMOX-CLAV","875-125MGTABLET","15","Select","Select",""],["","16714008110","HYDROXYZINE","HCL10MGTABLET","15","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":""}]}]}