{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cuong Pham","gend":0,"add":"1010 Jud Cole Rd","city":"Canon","state":"GA","zip":30520,"dob":"1985-11-09","age":"","mstatus":"","insh":4782770001,"cliId":"","pno":7064983732,"cno":"","email":"cuongpham@inbox.com","ename":"","eno":"","pphy":"Daniel Gordon","ppno":"","pcpadd":"137 West Athens St,Suite 10","pcpcity":"Winder","pcpstate":"GA","pcpzip":"","pcpcounty":"Winder","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":["E78.2","Z79.899","R53.83","R73.01","R94.5","R21","F33.41","R73.03","E11.9","R74.01","Z68.32","M79.89","E11.65","R06.2","F32.9","Z68.30","S91.331","Z68.31","F17.210","Z00.00","Z13.31","Z11.1","Z13.89","G47.09","F41.9","E55.9","F43.10","J45.20","R73.9","Z11.4","F17.200","L40.9","L40.0","K76.0","R74.8","L30.9","F51.01","Z23","H61.23","M25.50","D17.21"],"date":["2020-10-13","2021-07-27","2020-10-13","2020-10-13","2021-08-24","2021-06-15","2020-06-30","2020-06-30","2021-08-17","2021-11-23","2021-03-09","2021-06-29","2021-11-23","2021-11-23","2021-11-23","2021-05-11","2021-07-13","2021-11-23","2021-07-13","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-11-23","2021-11-23","2021-11-23","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2021-07-27","2021-08-24","2021-08-24","2020-03-31","2020-09-29","2020-09-29","2020-10-20","2020-10-13","2021-04-20"],"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":[["","68645056259","IBUPROFEN","600MGTABLET","30","Select","Select",""],["","65862052830","VENLAFAXINE","HCLER75MGCAP","30","Select","Select",""],["","173068220","VENTOLIN","HFA90MCGINHALER","18","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","68180045001","QUETIAPINE","FUMARATE400MGTAB","60","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","20","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","68645058259","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","93005301","BUSPIRONE","HCL5MGTABLET","60","Select","Select",""],["","42806054701","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","45802005505","TRIAMCINOLONE","0.001OINTMENT","454","Select","Select",""],["","70461032103","FLUCELVAX","QUAD2021-2022SYR","0.5","Select","Select",""],["","68180096301","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","115155510","FENOFIBRIC","ACIDDR135MGCAP","30","Select","Select",""],["","72205002790","ROSUVASTATIN","CALCIUM5MGTAB","30","Select","Select",""],["","69238153206","CLOBETASOL","0.0005CREAM","60","Select","Select",""],["","51672131001","BETAMETHASONE","DPAUG0.0005CRM","15","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":""}]}]}