{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLY HOLCOMBE","gend":1,"add":"3530 GA Highway 64 W","city":"Lakeland","state":"GA","zip":31635,"dob":"1988-08-17","age":"","mstatus":"","insh":4600867001,"cliId":"","pno":9125902319,"cno":"","email":"HOLCOMBEKELLY88@GMAIL.COM","ename":"","eno":"","pphy":"THOMAS MOSELEY","ppno":"","pcpadd":"220 Northside Dr","pcpcity":"Valdosta","pcpstate":"GA","pcpzip":"","pcpcounty":"Valdosta","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":["Z01.419","M25.571","E66.01","Z68.42","Z87.891","E28.2","Z13.21","Z01.810","R73.09","M89.271","M94.8X7","Z88.5","S82.891","I27.20","I07.1","M48.061","M48.02","M50.122","M51.16","M54.2","R05","R07.89","M79.18","S92.141","Z12.4","R06.02","I26.99","M89.9","M94.9","I36.1","R00.0","M47.892","I82.411","I82.431","S99.911","Z01.818"],"date":["2021-07-20","2021-12-08","2021-10-13","2021-10-13","2022-01-06","2021-06-15","2021-06-15","2021-06-15","2021-07-20","2021-12-08","2021-12-08","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2021-02-02","2021-02-02","2021-02-02","2021-10-20","2021-05-25","2021-10-20","2021-10-20","2022-01-06","2022-01-06","2021-10-20","2021-11-09","2021-09-22","2021-10-20","2021-10-20","2021-12-28","2021-06-29"],"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":[["","781506120","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","43386035610","HYDROCODONE-ACETAMIN","5-325MG","30","Select","Select",""],["","3089421","ELIQUIS","5MGTABLET","60","Select","Select",""],["","93214062","TRI-LO-SPRINTEC","TABLET","28","Select","Select",""],["","31722053301","METHOCARBAMOL","500MGTABLET","60","Select","Select",""],["","57664037718","TRAMADOL","HCL50MGTABLET","30","Select","Select",""],["","69097084615","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","70710114003","FLUCONAZOLE","200MGTABLET","3","Select","Select",""],["","59746017506","PREDNISONE","20MGTABLET","5","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","172392670","DIAZEPAM","5MGTABLET","12","Select","Select",""],["","64380071206","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","69680011399","CYANOCOBALAMIN","10000MCG\/10","10","Select","Select",""],["","172409660","BACLOFEN","10MGTABLET","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":""}]}]}