{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Andrew Hight","gend":0,"add":"360 S Avery SW Rd","city":"Rome","state":"GA","zip":30165,"dob":"1980-09-27","age":"","mstatus":"","insh":4417113001,"cliId":"","pno":7069368773,"cno":"","email":"arh524@gmail.com","ename":"","eno":"","pphy":"Randolph Sumner","ppno":"","pcpadd":"150 Gentilly Blvd","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":["R50.9","Z20.822","M79.671","S92.001","S92.321","K58.9","K21.9","G25.81","B34.9","F31.31","S92.061","L29.9","S92.011","M79.89","M79.661","G89.18","R05","J01.90"],"date":["2021-08-24","2021-08-24","2021-12-16","2022-01-06","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-08-24","2021-07-13","2021-11-23","2021-07-20","2021-08-24","2021-08-24","2021-08-24","2021-12-28","2021-09-28","2021-06-22"],"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":[["","70436005901","BUPROPION","HCLSR150MGTABLET","30","Select","Select",""],["","65862039010","ONDANSETRON","ODT4MGTABLET","20","Select","Select",""],["","68180016013","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","378064205","PREDNISONE","20MGTABLET","15","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","60","Select","Select",""],["","19515081852","FLULAVAL","QUAD2021-2022SYR","0.5","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","456114030","VIIBRYD","40MGTABLET","30","Select","Select",""],["","54452725","LITHIUM","CARBONATE300MGTAB","90","Select","Select",""],["","42858000201","OXYCODONE","HCL10MGTABLET","20","Select","Select",""],["","42858010301","OXYCODONE-ACETAMINOPHN","7.5-325","20","Select","Select",""],["","49483060450","IBUPROFEN","800MGTABLET","60","Select","Select",""],["","93321205","CLONAZEPAM","1MGTABLET","10","Select","Select",""],["","59779013712","CVS","ASPIRINEC325MGTABLET","30","Select","Select",""],["","42858010401","OXYCODONE-ACETAMINOPHEN","10-325","40","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":""}]}]}