{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Molly Fields","gend":1,"add":"92 Davidson Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"2007-06-29","age":"","mstatus":"","insh":679290004,"cliId":"","pno":7068786475,"cno":"","email":"","ename":"","eno":"","pphy":"James Gilbert","ppno":"","pcpadd":"4095 S Lee St","pcpcity":"Buford","pcpstate":"GA","pcpzip":"","pcpcounty":"Buford","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":["M25.561","F90.2","G89.29","Z82.61","Z68.54","F41.9","Z30.011","N92.6","Z32.02","J02.9","Z20.822","J06.9","F41.1","G47.09","Z20.828","S60.222","S60.212","J02.8","R05","R51.9","M79.642","Z00.121","Z23","R46.89","L60.0","L21.9","N92.5","G47.33","J30.2","L25.9","E55.9","Z68.51","Z00.129","H52.533","H52.4","R42","R55","H53.9","H04.123","H04.203","R09.81","R06.2","M25.532","Z13.31","Z03.818","S70.312"],"date":["2021-03-16","2021-12-14","2021-01-26","2021-01-26","2021-12-14","2021-12-21","2020-10-27","2020-10-27","2020-10-27","2021-09-28","2021-09-28","2021-09-28","2021-11-16","2021-11-16","2020-10-13","2020-06-09","2020-06-09","2021-02-02","2021-05-18","2021-09-28","2020-06-09","2020-09-29","2020-09-29","2020-12-08","2021-10-05","2021-03-30","2021-09-28","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-10-05","2020-09-29","2021-10-05","2021-10-05","2021-11-16","2021-11-16","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-05-18","2020-06-09","2020-12-08","2021-02-02","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":[["","65162027250","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","115180302","HYDROXYZINE","PAM25MGCAP","30","Select","Select",""],["","16714036004","MONO-LINYAH","28TABLET","28","Select","Select",""],["","51224000160","BENZONATATE","200MGCAPSULE","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","30","Select","Select",""],["","59417010510","VYVANSE","50MGCAPSULE","30","Select","Select",""],["","68462018022","MUPIROCIN","0.02OINTMENT","30","Select","Select",""],["","52565005630","TRIAMCINOLONE","0.001CREAM","30","Select","Select",""],["","16714072103","FLUOXETINE","HCL20MGCAPSULE","30","Select","Select",""],["","68462056529","NORG-EE","0.18-0.215-0.25\/0.035","28","Select","Select",""],["","61314065605","CIPROFLOXACIN","0.003EYEDROP","10","Select","Select",""],["","45802046564","KETOCONAZOLE","0.02SHAMPOO","120","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":""}]}]}