{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eric L Norton","gend":0,"add":"137 Sunshine Valley Rd","city":"Blue Ridge","state":"GA","zip":30513,"dob":"1967-11-18","age":"","mstatus":"","insh":4204940001,"cliId":"","pno":7064555890,"cno":"","email":"eln1967@gmail.com","ename":"","eno":"","pphy":"Charles Campbell","ppno":"","pcpadd":"1266 Highway 515 South,N","pcpcity":"Jasper","pcpstate":"GA","pcpzip":"","pcpcounty":"Jasper","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":["Z20.822","J01.00","Z68.38","I48.91","Z68.41","I10","K21.9","E66.9","F41.9","F51.04","G47.33","F39","M19.90","Z88.1","Z88.2","Z88.8","Z82.49","Z79.01","U07.1","R53.83","G47.00","I48.19","J32.9"],"date":["2021-12-28","2021-12-28","2021-12-28","2020-08-11","2020-02-11","2021-12-08","2020-02-11","2021-12-08","2020-08-11","2020-08-11","2020-02-11","2020-08-11","2020-08-11","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2021-12-08","2021-12-08","2020-08-11","2020-08-11","2020-08-11"],"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":[["","13668000810","ZOLPIDEM","TARTRATE10MGTABLET","30","Select","Select",""],["","68382059516","DILTIAZEM","24HER(CD)120MGCP","30","Select","Select",""],["","65862067705","ALPRAZOLAM","0.5MGTABLET","30","Select","Select",""],["","59746017306","PREDNISONE","10MGTABLET","28","Select","Select",""],["","60505008000","SOTALOL","80MGTABLET","60","Select","Select",""],["","378623201","CITALOPRAM","HBR20MGTABLET","30","Select","Select",""],["","143992801","CIPROFLOXACIN","HCL500MGTAB","20","Select","Select",""],["","69097015915","MELOXICAM","15MGTABLET","30","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","27808006502","PROMETHAZINE-CODEINE","SOLUTION","240","Select","Select",""],["","42571016201","AMOX-CLAV","875-125MGTABLET","20","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":""}]}]}