{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Constance Perry","gend":1,"add":"223 Neil King Rd","city":"Cornelia","state":"GA","zip":30531,"dob":"1973-08-15","age":"","mstatus":"","insh":4445862001,"cliId":"","pno":7062448303,"cno":"","email":"connie.perry7@aol.com","ename":"","eno":"","pphy":"Derek Klemm","ppno":"","pcpadd":"396 Historic Hwy 441 N","pcpcity":"Demorest","pcpstate":"GA","pcpzip":"","pcpcounty":"Demorest","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":["J02.9","I10","F17.210","Z20.828","Z88.8","M25.50","Z00.01","E78.5","Z68.22","R87.610","R00.0","F32.2","B97.7","Z01.419","Z20.822","J40","Z87.891","R05","J01.00","E87.6","Z00.00","M79.671","F41.9","Z68.20","G25.81","Z13.31","S05.12X","W19.XXX","Z68.21"],"date":["2021-09-28","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-05-25","2020-06-30","2020-12-08","2020-06-30","2020-12-08","2020-06-30","2020-12-08","2020-12-08","2020-06-30","2021-10-13","2021-09-28","2021-09-28","2021-09-28","2021-03-02","2020-12-08","2020-06-16","2021-05-25","2021-05-25","2021-05-25","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17"],"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":[["","67877022305","GABAPENTIN","300MGCAPSULE","30","Select","Select",""],["","67877019805","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","43547028111","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","42571016201","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","45802008801","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","67877025115","TRIAMCINOLONE","0.001CREAM","15","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","59676058005","JANSSEN","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","120","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":""}]}]}