{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elva Sandoval","gend":1,"add":"540 Grove Level Rd","city":"Commerce","state":"GA","zip":30529,"dob":"1960-11-05","age":"","mstatus":"","insh":4815955001,"cliId":"","pno":7062248202,"cno":"","email":"cjoana03.jc@gmail.com","ename":"","eno":"","pphy":"SUSAN HAWN","ppno":"","pcpadd":"1244 Historic Homer Hwy","pcpcity":"Homer","pcpstate":"GA","pcpzip":"","pcpcounty":"Homer","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":["J12.82","R51.9","R06.02","Z79.899","Z79.84","I10","Z13.31","Z13.89","Z12.31","E78.2","Z68.38","M85.80","E55.9","R73.03","I83.893","U07.1","E11.9","Z00.00","R05","H11.32","T15.12X","L29.0","F41.8","Z12.4","E66.9","Z68.36","Z20.828"],"date":["2021-02-16","2021-02-16","2021-01-26","2021-01-26","2021-01-26","2021-03-30","2021-03-23","2021-03-23","2021-04-13","2021-03-30","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-02-16","2020-09-15","2020-09-15","2021-01-26","2021-02-23","2021-02-23","2020-09-22","2020-06-23","2020-11-24","2020-09-15","2020-09-15","2021-02-02"],"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":[["","68645058054","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","51672126302","NYSTATIN-TRIAMCINOLONE","CREAM","30","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MGTABLET","30","Select","Select",""],["","68645054459","METFORMIN","HCL500MGTABLET","30","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","8","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","21","Select","Select",""],["","713050324","ANUCORT-HC","25MGSUPPOSITORY","12","Select","Select",""],["","93505898","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","21","Select","Select",""],["","68645056354","IBUPROFEN","800MGTABLET","15","Select","Select",""],["","68645057054","CITALOPRAM","HBR20MGTABLET","30","Select","Select",""],["","68180096301","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","16714008110","HYDROXYZINE","HCL10MGTABLET","30","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":""}]}]}