{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathy Mobley","gend":1,"add":"1975 old jackson chapel rd","city":"cedartown","state":"GA","zip":30125,"dob":"1964-09-09","age":"","mstatus":"","insh":4554716001,"cliId":"","pno":4042270890,"cno":"","email":"none@aol.com","ename":"","eno":"","pphy":"NEIL GORDON","ppno":"","pcpadd":"2370 Rockmart Hwy,Suite 10","pcpcity":"Cedartown","pcpstate":"GA","pcpzip":"","pcpcounty":"Cedartown","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":["I25.10","Z00.00","I10","E55.9","Z13.29","Z13.220","H81.8X9","H90.41","R26.89","Z91.81","D33.3","J12.82","N17.9","E86.0","K21.9","R09.02","Z79.82","Z88.2","Z90.710","Z88.8","E66.9","Z68.33","I21.4","F41.9","E66.01","Z68.36","J44.9","F32.9","M79.2","R42","D75.1","N28.9","R07.9","I63.9","U07.1","Z68.41","Z23","R53.1","R50.9","Z20.822","D44.0","J96.01","N18.9","Z86.010","D12.3","K51.40","K62.1","K52.9","J45.20","H83.2X1","G35","H53.8","H91.90","R26.9","I67.82","Z86.018","M48.04","M47.814","M51.34","M47.812","M48.02","H91.92","E04.1","R29.6","R26.81","R43.8","R90.89","H91.91","H53.9","R25.1","K63.5","R91.8","R53.2","R90.82","D12.5","E04.2","H90.5","R07.2","Z98.890","I21.9","I63.233","H55.00"],"date":["2021-12-08","2020-08-18","2021-12-28","2020-08-18","2020-08-18","2020-08-18","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-12-21","2021-11-02","2021-10-20","2021-09-21","2021-12-28","2021-09-22","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-12-21","2021-09-21","2021-12-28","2021-06-08","2021-05-04","2021-05-04","2021-12-21","2021-03-30","2020-06-30","2021-11-09","2020-06-30","2020-06-30","2021-12-07","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-09-07","2021-09-07","2021-09-07","2021-06-22","2021-10-20","2021-10-20","2020-01-28","2020-01-28","2020-01-14","2020-01-28","2020-01-14","2021-06-08","2021-05-04","2021-07-27","2021-07-27","2021-07-27","2021-11-09","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-11-09","2021-07-27","2021-11-09","2021-07-27","2021-07-27","2021-11-09","2021-11-09","2021-11-09","2021-06-22","2020-01-14","2021-10-12","2021-06-22","2021-05-25","2020-01-28","2021-07-27","2021-05-04","2021-11-23","2021-05-04","2021-11-09","2021-06-29","2021-10-12"],"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":[["","51991070605","ALPRAZOLAM","1MGTABLET","90","Select","Select",""],["","68180063609","ATORVASTATIN","20MGTABLET","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","65862019405","FLUOXETINE","HCL40MGCAPSULE","30","Select","Select",""],["","43547027603","DONEPEZIL","HCL10MGTABLET","30","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","68382013610","LOSARTAN","POTASSIUM50MGTAB","60","Select","Select",""],["","68180071909","AMLODIPINE","BESYLATE2.5MGTAB","30","Select","Select",""],["","59762045001","COLESTIPOL","MICRONIZED1GMTAB","60","Select","Select",""],["","55111019605","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","54418225","DEXAMETHASONE","1.5MGTABLET","28","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4MGTABLETSL","25","Select","Select",""],["","62332000231","FAMOTIDINE","40MGTABLET","30","Select","Select",""],["","65862064130","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","55111064505","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","57237007630","ONDANSETRON","HCL8MGTABLET","20","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":""}]}]}