{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alicia Burciaga","gend":1,"add":"3626 Byers Rdg","city":"Gainesville","state":"GA","zip":30504,"dob":"1959-08-15","age":"","mstatus":"","insh":4414278001,"cliId":"","pno":6783162218,"cno":"","email":"alicia0815@yahoo.com","ename":"","eno":"","pphy":"Leah Mickelson","ppno":"","pcpadd":"4465 Nelson Brogdon Boulevard,N","pcpcity":"Buford","pcpstate":"GA","pcpzip":"","pcpcounty":"Buford","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":["G51.0","M25.60","R53.1","Z12.31","E03.9","M54.2","M54.41","R73.03","Z79.899","Z68.37","R51.9","Z23","Z00.00","R10.9","Z78.0","Z13.820","E78.5","G44.52","H35.341","H35.351","G24.3","Z13.30","M70.52","Z68.36","H53.9","Z20.822","H10.213"],"date":["2022-01-06","2021-12-21","2021-12-21","2021-09-01","2021-10-26","2021-12-21","2021-06-15","2021-10-26","2021-09-22","2021-11-09","2021-10-20","2021-10-20","2021-06-15","2021-09-01","2021-09-07","2021-09-07","2021-07-27","2022-01-06","2021-06-22","2021-06-22","2021-10-13","2021-04-06","2021-09-01","2021-08-17","2021-09-22","2022-01-06","2021-06-15"],"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":[["","70377000911","ROSUVASTATIN","CALCIUM40MGTAB","30","Select","Select",""],["","378181377","LEVOTHYROXINE","125MCGTABLET","30","Select","Select",""],["","70710122600","AMITRIPTYLINE","HCL25MGTAB","30","Select","Select",""],["","49483060350","IBUPROFEN","600MGTABLET","15","Select","Select",""],["","69097084507","CYCLOBENZAPRINE","5MGTABLET","30","Select","Select",""],["","16571020210","DICLOFENAC","SODEC50MGTAB","40","Select","Select",""],["","143992801","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","68382075810","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","378064010","PREDNISONE","5MGTABLET","131","Select","Select",""],["","69097015907","MELOXICAM","15MGTABLET","30","Select","Select",""],["","31722070530","VALACYCLOVIR","HCL1GRAMTABLET","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":""}]}]}