{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Prakash Patel","gend":0,"add":"110 Running Creek Dr","city":"Warner Robins","state":"GA","zip":31088,"dob":"1976-12-10","age":"","mstatus":"","insh":4829708001,"cliId":"","pno":2298600027,"cno":"","email":"peterpatel07@gmail.com","ename":"","eno":"","pphy":"GAYATRI KAMAT","ppno":"","pcpadd":"623 S Houston Lake Rd,Suite 50","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":["R10.9","K59.01","E78.2","R73.03","H53.8","R03.0","K75.81","G25.81","G47.62","G47.33","J45.998","F17.220","Z00.01","R73.09","N20.0","H43.393","H52.4","H04.129","R63.4","N20.1","N13.2","R10.12","K04.7","K59.09","F10.20","Z68.23"],"date":["2021-06-15","2021-06-15","2021-07-13","2021-07-13","2021-06-15","2021-07-13","2021-06-15","2021-06-15","2021-07-13","2021-07-13","2021-01-06","2021-07-13","2021-07-13","2021-06-01","2021-06-15","2021-04-27","2021-04-27","2021-07-13","2021-06-15","2021-02-11","2021-04-06","2021-02-02","2021-07-13","2021-07-13","2021-07-13","2021-07-13"],"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":[["","406048410","ACETAMINOPHEN-COD","#3TABLET","10","Select","Select",""],["","57237001401","TAMSULOSIN","HCL0.4MGCAPSULE","14","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","69097015907","MELOXICAM","15MGTABLET","30","Select","Select",""],["","45802086866","POLYETHYLENE","GLYCOL3350POWD","28","Select","Select",""],["","245007111","POTASSIUM","CITRATEER10MEQTB","28","Select","Select",""],["","65862018730","ONDANSETRON","HCL4MGTABLET","14","Select","Select",""],["","75826011410","PHENAZOPYRIDINE","100MGTAB","15","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","63304069301","CLINDAMYCIN","HCL300MGCAPSULE","30","Select","Select",""],["","68180016006","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","49483060450","IBUPROFEN","800MGTABLET","30","Select","Select",""],["","603497528","OXYBUTYNIN","5MGTABLET","10","Select","Select",""],["","13668058010","LACTULOSE","10GM\/15MLSOLUTION","300","Select","Select",""],["","93031401","KETOROLAC","10MGTABLET","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}