{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lacey Johnson","gend":1,"add":"615 Wilson Rd","city":"Chatsworth","state":"GA","zip":30705,"dob":"1985-03-12","age":"","mstatus":"","insh":4287149002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"JAMES BROWN","ppno":"","pcpadd":"320 Market St","pcpcity":"Chatsworth","pcpstate":"GA","pcpzip":"","pcpcounty":"Chatsworth","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":["L71.9","K29.80","R12","E66.01","Z68.37","K21.9","F41.9","Z20.822","Z88.5","Z88.8","Z90.49","Z90.710","Z87.891","N95.1","N64.4","R53.83","N60.12","N60.11","Z01.419","K29.90","Z01.818","R30.0","B07.0","J11.1","Z12.31","Z23","R63.5","F41.8","Z63.79","M77.12","C50.919","Z71.9","E66.9","Z28.21","K29.60","R03.0","F34.1","R07.9","E66.09","Z68.39"],"date":["2021-09-07","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-11-02","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2020-03-24","2020-03-24","2020-08-18","2020-03-24","2020-03-24","2021-05-25","2021-10-26","2021-10-26","2021-03-09","2021-04-20","2020-02-11","2020-06-09","2021-03-02","2020-04-09","2020-08-18","2020-08-18","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2021-11-09","2020-05-05","2020-05-05","2021-12-07","2021-11-23","2021-11-23"],"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":[["","68382079101","ACYCLOVIR","400MGTABLET","30","Select","Select",""],["","45802056202","CLINDAMYCIN","PH0.01SOLUTION","60","Select","Select",""],["","45802046564","KETOCONAZOLE","0.02SHAMPOO","120","Select","Select",""],["","65862007701","CIPROFLOXACIN","HCL500MGTAB","2","Select","Select",""],["","51862036240","FLUOROURACIL","0.05CREAM","40","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","299382345","SOOLANTRA","0.01CREAM","45","Select","Select",""],["","69238126601","OSELTAMIVIR","PHOS75MGCAPSULE","10","Select","Select",""],["","591565805","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","781707787","METRONIDAZOLE","VAGINAL0.0075GL","70","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":""}]}]}