{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kenneth Parks","gend":0,"add":"502 Hickory Flat Rd","city":"Gillsville","state":"GA","zip":30543,"dob":"1967-10-18","age":"","mstatus":"","insh":4391540001,"cliId":"","pno":7068703850,"cno":"","email":"Akpsmile@yahoo.com","ename":"","eno":"","pphy":"LESLIE DAVID","ppno":"","pcpadd":"1315 Jesse Jewell Parkway Ste 300","pcpcity":"Gainesville","pcpstate":"GA","pcpzip":"","pcpcounty":"Gainesville","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":["U07.1","R05.9","H25.13","E11.9","Z00.00","Z68.36","N52.9","Z23","G47.33","L03.221","N40.0","Z12.5","Z12.11","R73.03","R05","Z20.822","R09.89","E66.9","M25.50","Z68.39","R21","J40","J01.90","L73.1"],"date":["2021-11-02","2021-11-02","2020-12-22","2020-12-22","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-08-10","2021-08-10","2021-03-23","2020-06-09","2020-06-09","2020-06-16","2020-06-09","2021-08-10","2020-02-18","2021-09-28"],"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":[["","23155010205","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","69097015815","MELOXICAM","7.5MGTABLET","30","Select","Select",""],["","173071620","ADVAIR","HFA115-21MCGINHALER","12","Select","Select",""],["","143928501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","69097014260","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","168020360","CLINDAMYCIN","PHOSP0.01LOTION","60","Select","Select",""],["","168008031","HYDROCORTISONE","0.025CREAM","30","Select","Select",""],["","93224001","CEPHALEXIN","500MGTABLET","30","Select","Select",""],["","42806071501","BENZONATATE","200MGCAPSULE","30","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","591544210","PREDNISONE","10MGTABLET","14","Select","Select",""],["","51672131201","MUPIROCIN","0.02OINTMENT","15","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","180","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","173068220","VENTOLIN","HFA90MCGINHALER","18","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":""}]}]}