{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Madison B Sissom","gend":1,"add":"30A FOUNTAIN SQ NW","city":"ROME","state":"GA","zip":30165,"dob":"1999-08-03","age":"","mstatus":"","insh":4244186001,"cliId":"","pno":7062370595,"cno":"","email":"dweaver6604@yopmail.com","ename":"","eno":"","pphy":"WILMA BRIONES MULL","ppno":"","pcpadd":"1328 Joe Frank Harris Parkway SE","pcpcity":"Cartersville","pcpstate":"GA","pcpzip":"","pcpcounty":"Cartersville","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":["J20.9","Z01.419","Z30.430","E66.9","K21.9","Z78.9","G43.909","R05","Z20.822","J00","N93.8","F41.8","E28.2","Z90.49","K58.9","K52.9","Z11.3","T83.39X","N39.0","J02.9","Z30.09","E11.9","J45.909","R30.0","B37.3","E66.01","T83.32X","N30.00"],"date":["2021-05-18","2020-11-24","2020-08-25","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2021-06-29","2021-12-07","2021-12-07","2021-08-24","2021-12-07","2021-11-30","2021-12-07","2021-12-07","2021-06-15","2020-11-24","2020-09-22","2021-08-10","2021-05-25","2020-08-04","2020-09-15","2020-09-15","2020-12-29","2020-12-29","2021-12-07","2020-08-25","2020-06-30"],"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":[["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","59762500801","MISOPROSTOL","200MCGTABLET","4","Select","Select",""],["","555902858","JUNEL","FE1.5MG-30MCGTABLET","28","Select","Select",""],["","53746051101","SPIRONOLACTONE","25MGTABLET","60","Select","Select",""],["","47781030301","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","150MGTABLET","2","Select","Select",""],["","59651000305","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","378064205","PREDNISONE","20MGTABLET","10","Select","Select",""],["","65162068090","PROMETHAZINE-DM","6.25-15MG\/5ML","120","Select","Select",""],["","68462010530","ONDANSETRON","HCL4MGTABLET","9","Select","Select",""],["","68180016011","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","50111064701","FLUOXETINE","HCL10MGCAPSULE","30","Select","Select",""],["","93081001","NORTRIPTYLINE","HCL10MGCAP","30","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","28","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","67877057305","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}