{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alissa Bennett","gend":1,"add":"1201 Nelson St","city":"Dalton","state":"GA","zip":30721,"dob":"1981-12-09","age":"","mstatus":"","insh":4631503001,"cliId":"","pno":7062801114,"cno":"","email":"alissabennett36@gmail.com","ename":"","eno":"","pphy":"Linda Kim","ppno":"","pcpadd":"2200 East 3rd Street,Suite 20","pcpcity":"Chattanooga","pcpstate":"TN","pcpzip":"","pcpcounty":"Chattanooga","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":["S82.52X","G90.522","F41.9","M25.561","M25.562","J30.1","J30.81","J30.89","S82.55X","M25.572","G43.909","R11.0","J45.50","K21.9","J40"],"date":["2022-01-04","2021-12-07","2021-11-02","2022-01-04","2022-01-04","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-10-26","2021-01-05","2021-01-05","2020-12-29","2020-12-29","2020-09-15"],"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":[["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","29300022019","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","65162067684","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","57664037713","TRAMADOL","HCL50MGTABLET","12","Select","Select",""],["","68645051954","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","31722099601","HYDROCODONE-ACETAMIN","5-325MG","28","Select","Select",""],["","186037020","SYMBICORT","160-4.5MCGINHALER","10.2","Select","Select",""],["","16714079801","SUMATRIPTAN","SUCC100MGTABLET","9","Select","Select",""],["","487980125","IPRATROPIUM","BR0.0002SOLN","62.5","Select","Select",""],["","59267100002","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MGTABLET","30","Select","Select",""],["","597008717","ATROVENT","17MCGHFAINHALER","12.9","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","24","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":""}]}]}