{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Katherine L Joiner","gend":1,"add":"1926 Fairfield Dr","city":"Dalton","state":"GA","zip":30720,"dob":"1971-06-19","age":"","mstatus":"","insh":4617750001,"cliId":"","pno":7062775035,"cno":"","email":"Kathyjoiner443@hotmail.com","ename":"","eno":"","pphy":"David Carson","ppno":"","pcpadd":"1209 W Walnut Ave,Suite ","pcpcity":"Dalton","pcpstate":"GA","pcpzip":"","pcpcounty":"Dalton","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":["R73.09","J30.9","Z79.899","Z23","H40.221","H40.222","Z12.31","E78.00","J02.9","J01.90","J34.2","H40.113","Z12.4","J31.0","J01.91","H90.3","H40.223"],"date":["2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-06-15","2021-06-15","2021-08-31","2020-10-20","2020-02-11","2021-04-27","2021-04-27","2021-12-28","2020-11-24","2021-03-30","2021-03-30","2021-03-30","2021-04-06"],"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":[["","55111057503","IBANDRONATE","SODIUM150MGTAB","1","Select","Select",""],["","23320503","LUMIGAN","0.0001EYEDROPS","2.5","Select","Select",""],["","23921105","COMBIGAN","0.2%-0.5%EYEDROPS","5","Select","Select",""],["","24208048510","DORZOLAMIDE","HCL0.02EYEDROPS","10","Select","Select",""],["","58160082311","SHINGRIX","VIALKIT","1","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","67877021620","CEFUROXIME","AXETIL500MGTAB","14","Select","Select",""],["","781185220","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","24208050707","LOTEMAX","SM0.0038OPHTHGEL","5","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":""}]}]}