{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bruce k Hardy","gend":0,"add":"813 Main Street","city":"Byron","state":"GA","zip":31008,"dob":"1966-10-07","age":"","mstatus":"","insh":4630076001,"cliId":"","pno":4783904606,"cno":"","email":"brucehardy1966@yahoo.com","ename":"","eno":"","pphy":"MOHAMMED AJJAN","ppno":"","pcpadd":"312 Margie Dr","pcpcity":"Warner Robins","pcpstate":"GA","pcpzip":"","pcpcounty":"Warner Robins","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":["S32.011","F11.20","S32.012","I10","G89.4","K59.03","Z98.890","R91.8","M51.16","M48.061","S09.90X","M54.5","K59.00","F17.210","F12.90","K76.0","Z72.89","S32.010","M54.2","S32.018","M54.6","M48.04","M47.814","M46.1","W13.2XX","S22.000","M54.9","S39.91X","S39.93X","S29.9XX"],"date":["2021-04-27","2020-12-29","2021-03-30","2021-01-19","2021-01-19","2021-01-19","2021-09-14","2021-03-23","2021-12-16","2021-12-16","2020-12-15","2021-11-23","2021-01-06","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-08","2020-12-15","2021-02-02","2021-04-06","2021-04-06","2021-09-14","2020-12-15","2021-04-27","2020-12-15","2020-12-15","2020-12-15","2020-12-15"],"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":[["","59267100002","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","68382013610","LOSARTAN","POTASSIUM50MGTAB","30","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","591565810","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","51991074790","DULOXETINE","HCLDR30MGCAP","30","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","21","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":""}]}]}