{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charles Bass","gend":0,"add":"6636 Amherst Dr","city":"Hoschton","state":"GA","zip":30548,"dob":"1958-05-13","age":"","mstatus":"","insh":4765744002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Robert Kelly","ppno":"","pcpadd":"73 Maxwell Ln","pcpcity":"Dahlonega","pcpstate":"GA","pcpzip":"","pcpcounty":"Dahlonega","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":["D04.4","Z00.00","I11.9","L57.8","D22.5","D22.62","D22.61","D22.71","D22.72","L82.1","L81.4","Z71.89","D48.5","L57.0","I25.10","E78.2","K86.1","J30.89","R73.03","Z68.26","Z12.5","M25.512","M24.811","J02.9","J02.0","K85.90","I42.8","H69.83","H60.63","J20.9","R05","J01.90","R39.15","K21.9","R63.8","H90.A21","H90.3","R73.01","Z98.890","R05.8","H25.13","H25.013"],"date":["2021-08-24","2021-11-09","2021-11-09","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-08-24","2021-07-06","2021-11-09","2021-11-09","2020-09-22","2021-11-09","2021-11-09","2021-11-09","2021-09-28","2021-09-28","2021-06-29","2021-06-29","2021-06-01","2021-07-06","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-03-16","2021-03-16","2021-07-06","2021-08-24","2021-08-24","2021-11-09","2021-11-09","2021-11-09","2021-07-27","2021-07-27"],"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":[["","68382009301","CARVEDILOL","6.25MGTABLET","60","Select","Select",""],["","68462019705","PRAVASTATIN","SODIUM40MGTAB","30","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","55111064505","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","68382013710","LOSARTAN","POTASSIUM100MGTAB","30","Select","Select",""],["","31722095801","BENZONATATE","200MGCAPSULE","42","Select","Select",""],["","33332042010","AFLURIA","QUAD2020-2021VIAL","0.5","Select","Select",""],["","781185220","AMOX-CLAV","875-125MGTABLET","10","Select","Select",""],["","406012401","HYDROCODONE-ACETAMIN","7.5-325","15","Select","Select",""],["","68382013210","TAMSULOSIN","HCL0.4MGCAPSULE","30","Select","Select",""],["","70461032103","FLUCELVAX","QUAD2021-2022SYR","0.5","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","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":""}]}]}