{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Hannah L Meeks","gend":1,"add":2859,"city":"Gainesville","state":"GA","zip":30507,"dob":"1991-08-07","age":"","mstatus":"","insh":4340150001,"cliId":"","pno":6785912636,"cno":"","email":"hsmith8791@gmail.com","ename":"","eno":"","pphy":"Brandee Urrutia","ppno":"","pcpadd":"4355 Browns Bridge Rd","pcpcity":"Cumming","pcpstate":"GA","pcpzip":"","pcpcounty":"Cumming","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"Oconee Cir","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":["M79.641","M67.431","M67.831","M54.5","M54.6","M65.841","R13.10","R10.13","R11.2","K31.89","K81.1","F45.8","K21.9","J45.998","F32.9","F41.9","E66.9","R73.03","E28.2","E55.9","F41.1","J45.20","K80.80","M67.441","B37.81","Z68.36","Z20.822","R94.5","E78.2","R35.0","R22.9","K80.20","Z01.818","K80.10","Z68.37","R73.09","K82.9","R74.01","Z71.3","Z12.11"],"date":["2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-09-14","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-03-30","2021-09-28","2021-09-28","2021-10-13","2021-10-13","2021-10-13","2021-09-28","2021-06-08","2021-06-08","2021-06-08","2021-11-02","2021-11-02","2021-06-08","2021-06-08","2021-11-02","2021-11-02","2021-08-17","2021-04-06","2021-09-28","2021-09-28","2021-09-28","2021-02-11","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-11-02"],"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":[["","65862055990","PANTOPRAZOLE","SODDR20MGTAB","30","Select","Select",""],["","66993058697","FLUTICASONE-SALMETEROL","500-50","60","Select","Select",""],["","69097014260","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","13668001005","CITALOPRAM","HBR20MGTABLET","30","Select","Select",""],["","68462010430","FLUCONAZOLE","200MGTABLET","15","Select","Select",""],["","13668013610","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","406012301","HYDROCODONE-ACETAMIN","5-325MG","15","Select","Select",""],["","57237007530","ONDANSETRON","HCL4MGTABLET","10","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MGTABLET","10","Select","Select",""],["","172392670","DIAZEPAM","5MGTABLET","2","Select","Select",""],["","781185220","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":""}]}]}