{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jealanie S Davis","gend":1,"add":"1355 Holly Creek Cool Sprgs Rd","city":"Chatsworth","state":"GA","zip":30705,"dob":"1961-09-18","age":"","mstatus":"","insh":4130757001,"cliId":"","pno":7062609604,"cno":"","email":"jealaniedavis@gmail.com","ename":"","eno":"","pphy":"JAMES BROWN","ppno":"","pcpadd":"320 Market St","pcpcity":"Chatsworth","pcpstate":"GA","pcpzip":"","pcpcounty":"Chatsworth","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","E03.9","Z12.39","J01.80","M62.838"],"date":["2021-07-06","2021-07-06","2021-07-06","2021-11-30","2021-09-28"],"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":[["","16714045202","QUETIAPINE","FUMARATE25MGTAB","30","Select","Select",""],["","55111017915","TIZANIDINE","HCL2MGTABLET","30","Select","Select",""],["","69097012215","TOPIRAMATE","25MGTABLET","30","Select","Select",""],["","16729044717","LEVOTHYROXINE","25MCGTABLET","30","Select","Select",""],["","2143611","EMGALITY","120MG\/MLPEN","1","Select","Select",""],["","65862037505","ESCITALOPRAM","20MGTABLET","30","Select","Select",""],["","23155019201","BUPROPION","HCL100MGTABLET","90","Select","Select",""],["","57237001899","DULOXETINE","HCLDR30MGCAP","41","Select","Select",""],["","16714066202","GABAPENTIN","300MGCAPSULE","270","Select","Select",""],["","16714069211","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","57664037713","TRAMADOL","HCL50MGTABLET","40","Select","Select",""],["","63323016212","KETOROLAC","30MG\/MLVIAL","20","Select","Select",""],["","16714001401","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.2","Select","Select",""],["","42806040021","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":""}]}]}