{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA SHOULDIERS","gend":1,"add":"1943 McFarland Ave","city":"Rossville","state":"GA","zip":30741,"dob":"1958-12-07","age":"","mstatus":"","insh":4200336001,"cliId":"","pno":7064198279,"cno":"","email":"teresa.shoulders@comcast.net","ename":"","eno":"","pphy":"David Denman","ppno":"","pcpadd":"4700 Battlefield Parkway,Suite 20","pcpcity":"Ringgold","pcpstate":"GA","pcpzip":"","pcpcounty":"Ringgold","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":["L60.1","L72.0","N18.9","I10","T81.30X","C50.911","G89.18","N64.4","I12.9","E66.01","Z68.42","C50.212","C50.012","Z17.0","K21.9","F17.210","Z86.73","Z88.1","Z88.7","Z88.0","Z91.041","Z88.8","Z86.010","Z98.890","Z98.51","Z79.899","C50.811","D12.3","K63.5","K64.0","Q43.8","E66.9","Z68.41","L50.8","R73.03","Z85.3","Z79.84","Z90.13","Z90.89","C50.411","R11.0","C50.912","D63.1","I44.7","I47.1","J30.2","Z85.828","R92.8","D48.61","D48.62","N64.59","C50.112","C77.3","N95.8","Z79.811","N60.99","R07.89","K56.2","D37.4","C50.812","I70.0","Z12.11","R00.2","F17.200","Z90.12"],"date":["2021-12-21","2021-12-21","2022-01-06","2021-09-28","2021-09-28","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2021-06-22","2021-11-23","2021-12-28","2021-12-14","2021-12-28","2021-06-22","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-28","2021-12-14","2021-08-24","2021-12-14","2021-07-06","2021-12-28","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-11-23","2021-11-23","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-10-05","2021-10-05","2021-12-07","2021-12-07","2021-08-17","2021-08-17","2021-12-14","2021-12-28","2021-11-23","2021-07-20","2021-12-28","2021-06-15","2021-08-24","2021-08-24"],"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":[["","65862078030","OLMESARTAN-HCTZ","40-12.5MGTAB","30","Select","Select",""],["","29300012601","BISOPROLOL","FUMARATE5MGTAB","30","Select","Select",""],["","23155050001","HYDROXYZINE","HCL10MGTABLET","90","Select","Select",""],["","574200830","NYSTOP","100000UNITS\/GMPOWDER","30","Select","Select",""],["","68001015504","ANASTROZOLE","1MGTABLET","30","Select","Select",""],["","16729003410","LETROZOLE","2.5MGTABLET","30","Select","Select",""],["","406055201","OXYCODONE","HCL5MGTABLET","40","Select","Select",""],["","65862037405","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","10","Select","Select",""],["","65862018601","CLINDAMYCIN","HCL300MGCAPSULE","42","Select","Select",""],["","93314705","CEPHALEXIN","500MGCAPSULE","21","Select","Select",""],["","57237007710","ONDANSETRON","ODT4MGTABLET","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":""}]}]}