{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Frances Knight","gend":1,"add":"1103 Rocky Lane","city":"Dalton","state":"GA","zip":30720,"dob":"1958-06-07","age":"","mstatus":"","insh":4201238001,"cliId":"","pno":4238763922,"cno":"","email":"franhayes58@yahoo.com","ename":"","eno":"","pphy":"NATALIE BESSOM","ppno":"","pcpadd":"1012 Burleyson Rd","pcpcity":"Dalton","pcpstate":"GA","pcpzip":"","pcpcounty":"Dalton","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":["M54.59","M79.18","M54.16","M25.551","Z79.899","M51.26","S69.91X","T14.8XX","I35.2","R07.89","R06.00","I34.0","E78.2","E03.9","D50.9","Z03.818","R03.0","J00","Z03.89","Z23","N30.01","N39.0","F43.22","R19.00","R94.39","E03.4","E55.9","R01.1","K21.9","G47.00","N95.1","Z87.891","E78.5","R81","M54.17","M54.5","S29.012","K59.09","M81.0","R22.41"],"date":["2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-10-12","2022-01-04","2022-01-04","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-03-30","2021-02-11","2021-02-11","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-11-09","2021-07-06","2021-07-06","2021-11-09","2021-11-09","2021-02-02","2021-11-09","2021-09-21","2021-05-11","2021-03-16","2021-03-16","2021-07-13"],"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":[["","16729000617","SIMVASTATIN","40MGTABLET","30","Select","Select",""],["","46110281","PREMARIN","0.625MGTABLET","30","Select","Select",""],["","59651000305","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","378353001","MIRTAZAPINE","30MGTABLET","30","Select","Select",""],["","16714063301","ALENDRONATE","SODIUM70MGTAB","4","Select","Select",""],["","16729044717","LEVOTHYROXINE","25MCGTABLET","30","Select","Select",""],["","43547040611","CLONAZEPAM","0.5MGTABLET","30","Select","Select",""],["","70461032103","FLUCELVAX","QUAD2021-2022SYR","0.5","Select","Select",""],["","52817033200","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","93005405","BUSPIRONE","HCL10MGTABLET","60","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":""}]}]}