{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stephon Gordon","gend":0,"add":"607 Woods Edge Way","city":"Warner Robins","state":"GA","zip":31088,"dob":"1992-07-30","age":"","mstatus":"","insh":4540597001,"cliId":"","pno":4782841735,"cno":"","email":"slmorgan721@yahoo.com","ename":"","eno":"","pphy":"IYAD AL-HUSEIN","ppno":"","pcpadd":"2510 Highway 127,N","pcpcity":"Kathleen","pcpstate":"GA","pcpzip":"","pcpcounty":"Kathleen","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":["J01.90","J45.909","K21.9","J45.901","R05","J20.9","S05.02X","Z01.00","Z13.31","Z30.09","Z71.3","Z71.82","I10","F41.9","R21","Z00.00","Z68.25","Z20.822","J01.00","J02.0","R07.0","M54.2","Z20.828","Z03.818","R07.9","R19.7","L70.0","R03.0","R13.10","R07.89","R11.0","Z80.0","Z83.71","M54.12"],"date":["2021-03-30","2020-04-09","2020-04-09","2020-12-08","2020-12-08","2020-12-08","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-09-02","2021-04-13","2021-04-13","2021-10-13","2021-10-13","2020-06-30","2021-03-30","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2021-09-02"],"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":[["","59651000305","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","49281041950","FLUZONE","QUAD2019-2020SYRINGE","0.5","Select","Select",""],["","69097083412","SERTRALINE","HCL50MGTABLET","30","Select","Select",""],["","53489011905","DOXYCYCLINE","HYCLATE100MGCAP","60","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","14","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","65862086001","FAMOTIDINE","40MGTABLET","60","Select","Select",""],["","24208029505","TOBRAMYCIN-DEXAMETH","OPHTHSUSP","5","Select","Select",""],["","70710122600","AMITRIPTYLINE","HCL25MGTAB","30","Select","Select",""],["","13668013501","ESCITALOPRAM","5MGTABLET","30","Select","Select",""],["","51672408104","CLINDAMYCIN","PH0.01SOLUTION","60","Select","Select",""],["","254100752","ALBUTEROL","HFA90MCGINHALER","6.7","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":""}]}]}