{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jessica Govern","gend":1,"add":"107 Striker Rd","city":"Cedartown","state":"GA","zip":30125,"dob":"1992-04-13","age":"","mstatus":"","insh":4558902001,"cliId":"","pno":6789017903,"cno":"","email":"Jgba87@gmail.com","ename":"","eno":"","pphy":"PAMELA HEARN","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":["D64.9","F31.9","Z87.891","M47.26","E66.9","Z68.35","M54.5","M43.17","M25.552","M43.10","Z82.49","Z72.0","F41.9","Z98.1","Z51.89","Z03.818","Z20.822","R10.9","M54.6","R07.9","M54.2","S19.9XX","J06.9","S09.90X","S79.919","R05","M48.07","M47.816","M47.896","M43.00","F41.1","M54.16","R20.2","M48.062","Q76.2","Z68.34","E66.09","Z71.3","Z71.82","R51","F32.9","E66.01","Z68.41","R53.83","R59.1","M43.06","R59.0","G89.29","M51.16","M51.17","M53.3","M99.04","G89.4","Z79.899","Z48.89","J20.9","Z20.828","Z01.812","M25.559","M25.569","M51.37","M51.26","R03.0","R79.89","R63.5"],"date":["2021-10-12","2021-10-12","2021-11-16","2021-10-12","2021-10-12","2021-10-12","2021-11-30","2021-02-09","2021-11-16","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2021-12-16","2021-05-04","2021-03-02","2021-11-09","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2020-09-01","2020-08-11","2020-12-15","2020-06-09","2020-06-09","2021-10-12","2021-10-12","2020-09-29","2020-09-29","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-04-28","2021-10-12","2021-06-01","2021-06-01","2020-04-28","2020-09-29","2020-10-13","2020-02-04","2020-12-01","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-04-06","2020-09-01","2020-09-01","2020-09-29","2021-10-05","2021-10-05","2020-04-21","2020-08-11","2021-10-12","2021-10-12","2021-04-27"],"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":[["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","60432060416","PROMETHAZINE-DM","SYRUP","200","Select","Select",""],["","16729013716","CLONAZEPAM","1MGTABLET","30","Select","Select",""],["","70010077001","METHOCARBAMOL","750MGTABLET","40","Select","Select",""],["","51991074890","DULOXETINE","HCLDR60MGCAP","30","Select","Select",""],["","10702005601","OXYCODONE","HCL10MGTABLET","90","Select","Select",""],["","68645056354","IBUPROFEN","800MGTABLET","90","Select","Select",""],["","93081201","NORTRIPTYLINE","HCL50MGCAP","60","Select","Select",""],["","93100301","BUSPIRONE","HCL15MGTABLET","60","Select","Select",""],["","67877022310","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","72205001290","PREGABALIN","50MGCAPSULE","60","Select","Select",""],["","49281042050","FLUZONE","QUAD2020-2021SYRINGE","0.5","Select","Select",""],["","68645052254","SERTRALINE","HCL50MGTABLET","30","Select","Select",""],["","59385002660","BELBUCA","750MCGFILM","60","Select","Select",""],["","31722071390","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","69547035302","NARCAN","4MGNASALSPRAY","2","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":""}]}]}