{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christopher Westmoreland","gend":0,"add":"64 Ash Wood Ln","city":"Cleveland","state":"GA","zip":30528,"dob":"1979-04-11","age":"","mstatus":"","insh":4462083001,"cliId":"","pno":7067686639,"cno":"","email":"Christopherwestmoreland1@cheechytees.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":["D69.6","I10","F41.8","K42.9","K59.00","Z13.31","Z68.34","J02.0","R50.9","Z20.822","J01.00","R06.2","R03.0","R05.1","M25.562","E55.9","Z86.19","Z11.4","Z68.32","D69.49","B18.2","Z13.89","E66.8","K74.60","R53.1","R16.1","K76.0","R79.89","F17.210","B19.20","R60.0"],"date":["2020-12-01","2021-10-26","2021-04-27","2020-10-20","2021-03-02","2021-10-26","2020-12-08","2020-02-18","2020-02-11","2021-11-02","2022-01-04","2021-11-02","2021-11-02","2021-11-02","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2020-12-08","2020-12-29","2021-04-27","2021-04-27","2020-12-08","2020-02-18","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08"],"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":[["","68645055754","LISINOPRIL-HCTZ","20-12.5MGTAB","30","Select","Select",""],["","68645056954","CITALOPRAM","HBR10MGTABLET","30","Select","Select",""],["","65162019011","NAPROXEN","500MGTABLET","60","Select","Select",""],["","68645055554","LISINOPRIL","40MGTABLET","30","Select","Select",""],["","29300013005","HYDROCHLOROTHIAZIDE","12.5MGCP","30","Select","Select",""],["","69097014260","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","143928501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","67877019805","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","59746017310","PREDNISONE","10MGTABLET","12","Select","Select",""],["","31722063231","OSELTAMIVIR","PHOS75MGCAPSULE","10","Select","Select",""],["","74262528","MAVYRET","100-40MGTABLET","84","Select","Select",""],["","69238110002","DOXYCYCLINE","HYCLATE100MGCAP","10","Select","Select",""],["","143924920","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","15","Select","Select",""],["","527193206","CLARITHROMYCIN","500MGTABLET","20","Select","Select",""],["","55111015430","ONDANSETRON","HCL8MGTABLET","12","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":""}]}]}