{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Daniel C Shumaker","gend":0,"add":"112 Shoe Factory Rd","city":"Blairsville","state":"GA","zip":30512,"dob":"1976-04-29","age":"","mstatus":"","insh":4192695002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Kathryn Blocker","ppno":"","pcpadd":"11 Hospital Way,Suite ","pcpcity":"Blairsville","pcpstate":"GA","pcpzip":"","pcpcounty":"Blairsville","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","R53.83","F41.1","Z68.30","Z13.89","S59.912","R60.9","S09.20X","J02.9","R51.9","R41.840","F17.210","Z68.26","H66.91","R00.0","D45","Z23"],"date":["2021-05-18","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-05-18","2021-05-18","2021-11-18","2021-03-02","2021-03-02","2020-08-11","2021-05-18","2020-08-11","2020-02-04","2020-02-04","2020-02-04","2020-02-04"],"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":[["","68645057054","CITALOPRAM","HBR20MGTABLET","30","Select","Select",""],["","31722094201","HYDROCODONE-ACETAMIN","7.5-325","15","Select","Select",""],["","68645059354","LISINOPRIL","40MGTABLET","30","Select","Select",""],["","68645052154","SERTRALINE","HCL25MGTABLET","30","Select","Select",""],["","67877021905","CEPHALEXIN","500MGCAPSULE","14","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","62037083110","METOPROLOL","SUCCER50MGTAB","30","Select","Select",""],["","69046956","CHANTIX","1MGTABLET","71","Select","Select",""],["","24208041005","OFLOXACIN","0.003EARDROPS","5","Select","Select",""],["","555097402","DEXTROAMP-AMPHETAMIN","30MGTAB","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":""}]}]}