{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jennifer Thomas","gend":1,"add":"1676 Town Creek Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"1984-09-25","age":"","mstatus":"","insh":4715557001,"cliId":"","pno":7063199555,"cno":"","email":"jenniferthomas@cheechytees.com","ename":"","eno":"","pphy":"DENISE WORKMAN","ppno":"","pcpadd":"55 Cantrell Road Ste 100","pcpcity":"Cleveland","pcpstate":"GA","pcpzip":"","pcpcounty":"Cleveland","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":["J12.89","J96.91","C90.00","Z68.42","M79.10","R03.0","D72.819","R79.89","E66.01","E03.9","Z87.442","Z91.013","Z91.040","Z00.00","Z28.3","I10","F33.1","E55.9","E53.8","R05","R50.9","Z86.16","Z79.899","R06.02","N20.1","D47.2","E85.9","C90.01","U07.1","Z13.31","Z13.39","D72.829","Z13.6","R07.9","Z82.49","J96.00","E78.5","N20.0","R10.11","R10.31","Z20.828","J18.9"],"date":["2021-02-02","2020-12-22","2021-11-09","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2021-01-06","2021-07-13","2022-01-06","2020-12-22","2020-12-22","2020-12-22","2021-10-20","2021-10-20","2022-01-06","2021-10-20","2021-10-20","2021-10-20","2020-12-22","2021-01-06","2021-05-25","2021-05-25","2021-01-06","2020-06-23","2020-05-19","2020-05-19","2021-07-13","2021-02-02","2021-05-04","2021-05-04","2020-12-15","2020-04-09","2020-03-10","2020-03-10","2021-02-02","2022-01-06","2020-07-28","2020-07-28","2020-07-28","2020-08-18","2021-01-06"],"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":[["","70069000510","CYANOCOBALAMIN","1000MCG\/ML","4","Select","Select",""],["","64380080707","IBUPROFEN","800MGTABLET","60","Select","Select",""],["","68382013201","TAMSULOSIN","HCL0.4MGCAPSULE","20","Select","Select",""],["","59746017310","PREDNISONE","10MGTABLET","21","Select","Select",""],["","487950160","ALBUTEROL","SUL2.5MG\/3MLSOLN","360","Select","Select",""],["","31722070190","LOSARTAN","POTASSIUM50MGTAB","30","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","168008031","HYDROCORTISONE","0.025CREAM","30","Select","Select",""],["","16714061205","SERTRALINE","HCL50MGTABLET","30","Select","Select",""],["","69238183901","LEVOTHYROXINE","175MCGTABLET","60","Select","Select",""],["","16714047802","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","69315012710","FOLIC","ACID1MGTABLET","30","Select","Select",""],["","33342025866","OSELTAMIVIR","PHOS75MGCAPSULE","10","Select","Select",""],["","13811071910","NITROFURANTOIN","MONO-MCR100MG","20","Select","Select",""],["","93831118","ELETRIPTAN","HBR40MGTABLET","4","Select","Select",""],["","60432060416","PROMETHAZINE-DM","SYRUP","60","Select","Select",""],["","43547035311","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","16714069211","FLUCONAZOLE","150MGTABLET","4","Select","Select",""],["","43598021085","SSD","0.01CREAM","170","Select","Select",""],["","597002402","COMBIVENT","RESPIMAT20-100MCG","4","Select","Select",""],["","65862053820","LEVOFLOXACIN","750MGTABLET","7","Select","Select",""],["","54418625","DEXAMETHASONE","6MGTABLET","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":""}]}]}