{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PRAVIN B PATEL","gend":0,"add":"3136 New Rosedale Rd NE","city":"Calhoun","state":"GA","zip":30701,"dob":"1961-06-01","age":"","mstatus":"","insh":979485002,"cliId":"","pno":"(706) 766-5892","cno":"","email":"","ename":"","eno":"","pphy":"SHALINI REDDY","ppno":"","pcpadd":"1825 Martha Berry Boulevard NW","pcpcity":"Rome","pcpstate":"GA","pcpzip":"","pcpcounty":"Rome","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":["N18.6","N17.9","I12.9","E11.22","N18.3","E78.5","E11.21","N25.0","Z11.59","R94.39","Z72.0","R80.9","E66.3","Z68.25","R07.89","I50.32","E11.65","I10","F17.200","Z68.27","I20.9","Z00.00","I50.30","Z45.2","I26.99","N18.32","E55.9","I25.10","Z95.5","F17.210","I51.9","I11.0","E11.9","I51.0","R94.31","Z01.810","R73.03","I13.10","D72.829","E78.2","N25.81","I70.1","E53.8","I25.118","I25.110","Z23","R94.5","R07.2","N17.8","Z87.891","I50.1","R00.1","Z91.19","M25.512","R06.09","E13.29","Z68.24","E87.2"],"date":["2020-05-19","2020-09-08","2021-07-06","2021-07-06","2020-10-20","2021-07-20","2020-09-08","2020-09-08","2020-09-08","2021-07-20","2021-12-16","2020-09-08","2020-09-08","2021-07-20","2020-04-21","2020-04-21","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2020-05-26","2020-12-01","2020-12-01","2020-06-23","2020-06-23","2021-12-28","2021-12-28","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2020-09-01","2020-09-01","2020-04-28","2020-04-28","2021-11-02","2021-08-05","2021-12-16","2021-07-06","2021-12-16","2021-09-28","2020-07-14","2020-05-12","2020-11-24","2020-07-07","2020-05-12","2020-05-19","2020-08-04","2020-06-30","2020-06-09","2020-04-28","2021-11-02","2020-06-02","2020-06-02","2020-06-30","2020-11-17"],"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":[["","31722070290","LOSARTAN","POTASSIUM100MGTAB","30","Select","Select",""],["","68462063945","NITROGLYCERIN","0.4MGTABLETSL","25","Select","Select",""],["","67877019805","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","93505698","ATORVASTATIN","10MGTABLET","30","Select","Select",""],["","69543012550","GLIMEPIRIDE","4MGTABLET","30","Select","Select",""],["","65862035790","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","29300013501","CLONIDINE","HCL0.1MGTABLET","60","Select","Select",""],["","68382065005","ISOSORBIDE","MONONITER30MGTB","60","Select","Select",""],["","59779060027","CVS","ASPIRINEC81MGTABLET","30","Select","Select",""],["","70377000911","ROSUVASTATIN","CALCIUM40MGTAB","30","Select","Select",""],["","50111039701","HYDRALAZINE","100MGTABLET","90","Select","Select",""],["","80777027398","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","57664050658","METOPROLOL","TARTRATE25MGTAB","60","Select","Select",""],["","186077760","BRILINTA","90MGTABLET","60","Select","Select",""],["","33342004907","IRBESARTAN","300MGTABLET","30","Select","Select",""],["","49035056314","EQ","ASPIRINEC81MGTABLET","30","Select","Select",""],["","65702028810","ACCU-CHEK","FASTCLIXLANCETDRUM","100","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":""}]}]}