{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Armon Hughey","gend":1,"add":"114 Hawks Ridge Trce","city":"Byron","state":"GA","zip":31008,"dob":"1957-02-04","age":"","mstatus":"","insh":4828593001,"cliId":"","pno":4789798180,"cno":"","email":"","ename":"","eno":"","pphy":"Nisreen Jallad","ppno":"","pcpadd":"1707 Watson Boulevard,N","pcpcity":"Warner Robins","pcpstate":"GA","pcpzip":"","pcpcounty":"Warner Robins","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":["Z01.89","Z13.228","Z13.21","Z13.29","Z13.1","Z13.0","Z13.220","Z12.31","Z80.3","Z71.3","Z71.82","I83.812","K21.9","M54.2","M47.816","G25.81","E78.2","E55.9","D50.8","J30.2","Z13.31","M25.512","Z13.9","I48.91","R07.2","D50.0","R35.0","M25.40","M54.12","M75.42","R94.31","R94.30","R00.2","I49.1","M79.604","M79.605","M47.892","Z90.49","Z90.710","I49.3","Z76.0","R11.0","Z87.898","Z12.39","R51.9","Z68.33","N30.00","R10.9","Z13.83","I49.8","I48.92","D50.9","Z82.49","Z12.11","Z13.820","I25.10","R91.1","R07.9","I49.9","Z12.12"],"date":["2020-09-08","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2021-03-23","2020-12-01","2021-12-28","2021-12-28","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-12-16","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-06-01","2021-07-06","2020-04-09","2021-12-16","2022-01-04","2020-12-01","2021-08-10","2021-02-02","2021-06-01","2021-12-16","2021-12-16","2021-08-10","2021-12-16","2021-09-07","2021-09-07","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-08-10","2020-05-12","2020-05-12","2020-05-12","2021-12-28","2021-12-28","2020-06-23","2020-09-15","2020-11-17","2020-06-09","2020-06-09","2021-08-10","2021-08-10","2021-09-23","2021-04-13","2021-12-16","2021-12-16","2021-05-18","2021-01-06","2021-09-23"],"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":[["","65162010250","GABAPENTIN","300MGCAPSULE","30","Select","Select",""],["","68001011204","LANSOPRAZOLE","DR30MGCAPSULE","30","Select","Select",""],["","62107002732","ASPIR","EC81MGTABLET","30","Select","Select",""],["","43547040011","CYCLOBENZAPRINE","10MGTABLET","90","Select","Select",""],["","69618004610","ASPIRIN","EC81MGTABLET","30","Select","Select",""],["","70377000315","SIMVASTATIN","20MGTABLET","30","Select","Select",""],["","55111018010","TIZANIDINE","HCL4MGTABLET","90","Select","Select",""],["","62175012841","ISOSORBIDE","MONONITER30MGTB","30","Select","Select",""],["","93720210","PRAVASTATIN","SODIUM40MGTAB","30","Select","Select",""],["","80777027310","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","603533932","PREDNISONE","20MGTABLET","10","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":""}]}]}