{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Yvonne KILGORE","gend":1,"add":"144 SWINT AVE SE","city":"MILLEDGEVILLE","state":"GA","zip":31061,"dob":"1961-08-27","age":"","mstatus":"","insh":4779879002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Eddie Richardson","ppno":"","pcpadd":"114 Harmony Crossing,Suite ","pcpcity":"Eatonton","pcpstate":"GA","pcpzip":"","pcpcounty":"Eatonton","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":["Z12.31","M54.2","M54.12","M54.13","Z00.00","I10","E78.2","F41.0","F41.9","R00.2","E66.3","Z68.26","Z79.899","M48.02","M47.812","M54.9","M50.123","R14.0","E78.5"],"date":["2021-09-01","2022-01-06","2021-12-07","2021-12-07","2021-06-29","2021-09-28","2021-06-29","2022-01-06","2022-01-06","2021-12-08","2021-12-08","2021-12-08","2021-11-18","2022-01-06","2021-12-28","2021-11-18","2022-01-06","2021-06-01","2021-09-28"],"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":[["","60505257909","ATORVASTATIN","20MGTABLET","30","Select","Select",""],["","93736756","LOSARTAN-HCTZ","50-12.5MGTAB","30","Select","Select",""],["","13668033101","TRAZODONE","100MGTABLET","30","Select","Select",""],["","781107710","ALPRAZOLAM","0.5MGTABLET","90","Select","Select",""],["","65862056099","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","55111064505","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","67877019905","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","69452014330","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","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":""}]}]}