{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Farren Bailey","gend":0,"add":"138 Wax Rd SE","city":"Silver Creek","state":"GA","zip":30173,"dob":"1961-08-23","age":"","mstatus":"","insh":4743963002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"WILMA BRIONES MULL","ppno":"","pcpadd":"1328 Joe Frank Harris Parkway SE","pcpcity":"Cartersville","pcpstate":"GA","pcpzip":"","pcpcounty":"Cartersville","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":["R50.9","R06.02","R05","Z20.828","M25.552","R53.83","R68.83","J12.89","R53.1","E87.6","J45.909","Z03.818","J20.9","U07.1","M16.12","Z00.00","M79.605","Z68.28","Z23","R53.81","G47.33","R00.0","R94.31","J06.9","R60.0","R51","R03.0","R11.0","M87.08","S43.492","R91.8"],"date":["2021-02-02","2021-02-02","2021-02-02","2020-07-07","2021-12-08","2020-05-19","2020-05-19","2021-02-02","2021-02-02","2021-02-02","2021-11-23","2021-08-24","2020-07-14","2020-08-25","2021-11-18","2020-08-18","2021-10-06","2021-10-06","2021-11-23","2021-11-23","2021-11-23","2020-09-01","2020-09-01","2020-09-01","2021-10-06","2020-08-18","2020-08-18","2020-08-18","2021-11-30","2021-11-30","2020-09-01"],"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":[["","31722072610","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","64380071306","BENZONATATE","200MGCAPSULE","30","Select","Select",""],["","67877021520","CEFUROXIME","AXETIL250MGTAB","20","Select","Select",""],["","76204020060","ALBUTEROL","SUL2.5MG\/3MLSOLN","180","Select","Select",""],["","65862064130","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","406012301","HYDROCODONE-ACETAMIN","5-325MG","20","Select","Select",""],["","68382009601","HYDROXYCHLOROQUINE","200MGTAB","22","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":""}]}]}