{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ashley Laney","gend":1,"add":"517 Laporte","city":"Rome","state":"GA","zip":30161,"dob":"1988-04-12","age":"","mstatus":"","insh":4762954001,"cliId":"","pno":6784922534,"cno":"","email":"laneya412@icloud.com","ename":"","eno":"","pphy":"Greta Flaherty","ppno":"","pcpadd":"1501 Shorter Avenue SW","pcpcity":"Rome","pcpstate":"GA","pcpzip":"","pcpcounty":"Rome","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","M25.50","G62.9","R53.83","N18.9","M71.22","J01.90","R06.02","N18.4","N17.0","R05","R52","F41.9","R00.2","Z87.891","R00.0","R94.31","R94.4","M79.605","R60.0","Z20.828","J06.9","N18.3","F17.200","R07.89","Z20.822","R39.9","M25.562","N27.0","J02.0","R11.0","R42","R07.1","R09.89","N18.32"],"date":["2021-09-21","2021-07-27","2021-08-03","2021-08-03","2020-09-29","2021-10-12","2021-10-12","2020-10-27","2020-05-19","2020-05-19","2021-08-31","2021-08-31","2020-08-04","2021-09-21","2021-09-21","2021-11-09","2021-11-09","2020-04-28","2021-09-02","2021-09-02","2020-10-27","2021-12-16","2020-08-04","2021-08-31","2021-09-21","2021-12-16","2021-12-16","2021-09-22","2020-11-10","2020-04-09","2020-10-27","2020-10-27","2021-10-26","2020-04-28","2020-11-10"],"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":[["","49483060650","GABAPENTIN","300MGCAPSULE","30","Select","Select",""],["","62332011291","METOPROLOL","TARTRATE25MGTAB","60","Select","Select",""],["","57237002901","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","54001825","PREDNISONE","20MGTABLET","10","Select","Select",""],["","69452017173","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","57237009960","CEFDINIR","300MGCAPSULE","14","Select","Select",""],["","68382004101","PROMETHAZINE","25MGTABLET","20","Select","Select",""],["","42571016242","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","49483060450","IBUPROFEN","800MGTABLET","20","Select","Select",""],["","57237004199","PENICILLIN","VK500MGTABLET","29","Select","Select",""],["","42806071405","BENZONATATE","100MGCAPSULE","20","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":""}]}]}