{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MORGAN SEAVER","gend":1,"add":"760 Slayton Dr","city":"Bethlehem","state":"GA","zip":30620,"dob":"1993-06-18","age":"","mstatus":"","insh":4631240001,"cliId":"","pno":7706019059,"cno":"","email":"morganseaver530@yahoo.com","ename":"","eno":"","pphy":"Audrey Huff","ppno":"","pcpadd":"63 West Candler St","pcpcity":"Winder","pcpstate":"GA","pcpzip":"","pcpcounty":"Winder","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":["I10","K21.9","R00.2","Z68.32","Z30.42","Z32.02","Z03.818","F43.12","F90.2","F81.9","Z01.419","Z71.3","Z71.82","J30.1","R63.8","N76.0","Z28.21","B96.89","Z68.28","Z00.00","Z13.31","Z97.3","Z80.8","F41.1","J30.9","E28.2","F31.9","F90.9","I47.9","Z79.3","J06.9","Z83.3","Z68.29","Z79.899","J01.10","N89.8","J01.00","Z68.31","H61.23","J45.30","H92.03"],"date":["2021-11-23","2021-08-10","2021-11-23","2020-11-10","2021-11-23","2021-11-23","2021-01-12","2021-11-09","2021-11-09","2021-11-09","2021-08-17","2020-08-18","2020-08-18","2020-05-12","2021-11-23","2021-09-28","2021-09-21","2021-09-28","2021-11-23","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-09-22","2021-06-15","2021-08-10","2021-11-23","2020-02-25","2021-08-17","2020-02-04","2021-01-19","2020-08-11","2020-08-11","2020-08-11"],"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":[["","13668004860","LAMOTRIGINE","150MGTABLET","60","Select","Select",""],["","69097083512","SERTRALINE","HCL100MGTABLET","30","Select","Select",""],["","55111046601","METOPROLOL","SUCCER25MGTAB","15","Select","Select",""],["","93354556","ATOMOXETINE","HCL40MGCAPSULE","30","Select","Select",""],["","173068220","VENTOLIN","HFA90MCGINHALER","18","Select","Select",""],["","59762453701","MEDROXYPROGESTERONE","150MG\/ML","1","Select","Select",""],["","47781026301","OXYCODONE","HCL5MGTABLET","8","Select","Select",""],["","49483060350","IBUPROFEN","600MGTABLET","16","Select","Select",""],["","116200116","CHLORHEXIDINE","0.0012RINSE","473","Select","Select",""],["","29300022701","METRONIDAZOLE","500MGTABLET","14","Select","Select",""],["","228202796","ALPRAZOLAM","0.25MGTABLET","2","Select","Select",""],["","57237002901","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","55111014512","FLUCONAZOLE","150MGTABLET","2","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MGTABLET","10","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":""}]}]}