{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joan Ricketson","gend":1,"add":"707 Alabama N St","city":"Broxton","state":"GA","zip":31519,"dob":"1968-06-14","age":"","mstatus":"","insh":4820997001,"cliId":"","pno":9123094224,"cno":"","email":"joanricketson@windstream.net","ename":"","eno":"","pphy":"LINDA BIXLER","ppno":"","pcpadd":"1101 Ocilla Rd","pcpcity":"Douglas","pcpstate":"GA","pcpzip":"","pcpcounty":"Douglas","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":["B97.4","J45.909","R05.9","R06.02","R06.00","G47.00","C43.9","J32.9","Z78.0","R05","K21.9","J30.2","M79.602","I10","M79.622","J01.00","Z20.822"],"date":["2021-12-28","2021-11-18","2021-11-18","2021-11-18","2021-12-28","2021-11-09","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-12-16","2021-12-28","2021-12-28"],"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":[["","13668000705","ZOLPIDEM","TARTRATE5MGTABLET","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","SODDR40MGTAB","60","Select","Select",""],["","16729011917","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","406996001","TEMAZEPAM","7.5MGCAPSULE","30","Select","Select",""],["","45802009735","ESTRADIOL","0.0001CREAM","42.5","Select","Select",""],["","59762372004","ALPRAZOLAM","0.5MGTABLET","30","Select","Select",""],["","13668013510","ESCITALOPRAM","5MGTABLET","30","Select","Select",""],["","68180071160","CEFDINIR","300MGCAPSULE","14","Select","Select",""],["","172392570","DIAZEPAM","2MGTABLET","60","Select","Select",""],["","76204020025","ALBUTEROL","SUL2.5MG\/3MLSOLN","150","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","20","Select","Select",""],["","33332032101","AFLURIA","QUAD2021-22(3YRUP)","0.5","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":""}]}]}