{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Suresh Pandya","gend":0,"add":"4770 Raley Rd","city":"Macon","state":"GA","zip":31206,"dob":"1940-08-19","age":"","mstatus":"","insh":4159602001,"cliId":"","pno":6307500116,"cno":"","email":"sureshpandya2016@gmail.com","ename":"","eno":"","pphy":"DIPESH PATEL","ppno":"","pcpadd":"5300 Zebulon Rd","pcpcity":"Macon","pcpstate":"GA","pcpzip":"","pcpcounty":"Macon","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","H54.7","Z13.1","E55.9","R53.83","Z13.220","E53.8","K21.9","Z01.818","M53.3","Z96.1","H25.11","H25.011","H18.413","H26.9","Z01.810","R68.89","H02.831","H02.834","H25.13","H25.013","H25.043","H04.123","H25.89"],"date":["2021-09-28","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-07-13","2021-07-13","2021-07-13","2021-12-16","2021-11-18","2021-12-21","2021-11-18","2021-12-28","2021-07-13","2021-07-13","2021-12-08","2021-12-08","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-20"],"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":[["","172572960","FAMOTIDINE","40MGTABLET","30","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","67877025180","TRIAMCINOLONE","0.001CREAM","80","Select","Select",""],["","378003210","METOPROLOL","TARTRATE50MGTAB","60","Select","Select",""],["","57664037718","TRAMADOL","HCL50MGTABLET","21","Select","Select",""],["","68462029817","CLOTRIMAZOLE-BETAMETHASONE","CRM","30","Select","Select",""],["","21922002107","PERMETHRIN","0.05CREAM","60","Select","Select",""],["","70461012103","FLUAD","QUAD2021-2022SYRINGE","0.5","Select","Select",""],["","61314063705","PREDNISOLONE","AC0.01EYEDROP","5","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":""}]}]}