{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martha S Cunningham","gend":1,"add":"1115 Happy Top Lane","city":"Hiawassee","state":"GA","zip":30546,"dob":"1957-11-27","age":"","mstatus":"","insh":4466407001,"cliId":"","pno":7068356105,"cno":"","email":"msuecunningham57@yahoo.com","ename":"","eno":"","pphy":" ","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","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":["K21.9","F17.210","J44.9","Z79.899","Z82.49","Z01.89","R10.13","L82.1","D22.5","Z87.2","Z85.828","D48.5","L57.0","Z08","K42.9","F41.9","M47.9","G89.29","M54.9","B96.81","Z20.822","F17.200","F33.9","F41.1","M51.26","Z01.818","K35.30","K29.70","Z68.24","R10.31","D12.3","K35.80","K38.1","R10.9","Z12.31","K43.0","K36","K43.2","R10.12","R10.11","K63.5","G89.18","K29.80","K35.31","K29.30","K20.90","J01.90","C44.519","R07.9","T45.1X5"],"date":["2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-08-24","2021-07-27","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-09-28","2021-09-28","2021-09-28","2021-12-28","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-12-28","2021-12-28","2021-12-28","2021-05-18","2021-08-03","2021-06-15","2021-07-27","2021-08-17","2021-08-17","2021-08-24","2021-08-10","2021-05-11","2022-01-06","2020-11-10","2021-08-05","2020-10-27","2021-06-22","2020-09-15","2021-08-10","2020-11-10","2021-06-01","2021-08-10","2021-05-25","2021-05-25","2021-11-30","2021-12-21","2021-08-05","2020-07-14"],"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":[["","406012501","HYDROCODONE-ACETAMIN","10-325MG","84","Select","Select",""],["","228203196","ALPRAZOLAM","1MGTABLET","56","Select","Select",""],["","65862018730","ONDANSETRON","HCL4MGTABLET","10","Select","Select",""],["","65862001205","SERTRALINE","HCL50MGTABLET","28","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","406055201","OXYCODONE","HCL5MGTABLET","10","Select","Select",""],["","65862022660","CLARITHROMYCIN","500MGTABLET","28","Select","Select",""],["","50111033402","METRONIDAZOLE","500MGTABLET","14","Select","Select",""],["","70954005820","PREDNISONE","5MGTABLET","28","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","68462039710","OMEPRAZOLE","DR40MGCAPSULE","14","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","62542030117","HYDROCODONE-CHLORPHEN","ERSUSP","60","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":""}]}]}