{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Opal Sullens","gend":1,"add":"392 Lewis Grendel RD","city":"Dahlonega","state":"GA","zip":30533,"dob":"1962-09-18","age":"","mstatus":"","insh":4419250001,"cliId":"","pno":7069737617,"cno":"","email":"opalsullens@gmail.com","ename":"","eno":"","pphy":"Piyushkumar Patel","ppno":"","pcpadd":"852 Dacula Rd","pcpcity":"Dacula","pcpstate":"GA","pcpzip":"","pcpcounty":"Dacula","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":["R39.15","N30.01","B96.81","R10.11","R11.10","R10.13","R11.0","N30.00","R30.0","D12.4","K64.1","K57.30","K92.1","K21.9","I10","K31.84","E78.00","A04.8","K62.5","K64.9","R11.2","H25.11","H25.812","H04.123","H16.223","H52.03","H52.4","R82.89","R31.9"],"date":["2021-11-30","2021-11-30","2021-11-30","2021-02-09","2021-11-30","2021-11-30","2021-11-23","2021-07-06","2021-07-06","2021-05-04","2021-04-27","2021-04-27","2021-04-27","2021-11-30","2021-11-23","2021-11-23","2021-08-17","2021-07-06","2021-03-30","2021-07-13","2021-02-02","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-11-09","2021-11-09"],"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":[["","57841115002","TALICIA","DR10-250-12.5MGCAP","42","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","31722071390","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","68645051054","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","29033000305","SUCRALFATE","1GMTABLET","90","Select","Select",""],["","65162068210","PHENAZOPYRIDINE","200MGTAB","15","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","68645056690","LOVASTATIN","20MGTABLET","30","Select","Select",""],["","55111015330","ONDANSETRON","HCL4MGTABLET","24","Select","Select",""],["","93220401","METOCLOPRAMIDE","5MGTABLET","90","Select","Select",""],["","65162047810","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","80777027398","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","378803093","LANSOPRAZOLE","DR30MGCAPSULE","28","Select","Select",""],["","527193206","CLARITHROMYCIN","500MGTABLET","28","Select","Select",""],["","50111056001","TRAZODONE","50MGTABLET","30","Select","Select",""],["","68382004101","PROMETHAZINE","25MGTABLET","40","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","56","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":""}]}]}