{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUDY SAWYER","gend":1,"add":"1205 Phillips Dr","city":"DALTON","state":"GA","zip":30720,"dob":"1958-04-13","age":"","mstatus":"","insh":"AM0007622001","cliId":"","pno":"(706) 264-6077","cno":"","email":"","ename":"","eno":"","pphy":"WESLEY STUCKEY","ppno":"","pcpadd":"1525 Chattanooga Rd","pcpcity":"Dalton","pcpstate":"GA","pcpzip":"","pcpcounty":"Dalton","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":["E87.1","M46.1","M16.11","R30.0","R35.0","I10","K21.9","E78.5","Z23","F41.1","R06.81","R06.83","R53.83","M54.16","M79.18","M48.062","M25.551","M54.5","R10.2","K64.0","Z87.891","M54.12","M16.0","M54.59","Z01.419","Z79.899","R11.0","Z12.11","M16.9","D47.3","D64.9","Z12.31","E66.3","M54.17","M47.896","G47.33"],"date":["2020-07-14","2021-12-28","2021-09-28","2020-03-31","2020-03-31","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-10-05","2021-04-27","2020-09-15","2020-09-15","2020-07-28","2021-12-28","2021-12-28","2020-11-24","2021-12-28","2021-12-28","2020-09-15","2021-06-08","2020-07-21","2020-07-21","2020-12-29","2021-06-29","2021-11-16","2021-10-19","2022-01-04"],"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":[["","42806008701","ESTRADIOL","0.5MGTABLET","90","Select","Select",""],["","42858010450","OXYCODONE-ACETAMINOPHEN","10-325","42","Select","Select",""],["","29300016910","TIZANIDINE","HCL4MGTABLET","14","Select","Select",""],["","67877019805","AMLODIPINE","BESYLATE5MGTAB","90","Select","Select",""],["","55111012705","CIPROFLOXACIN","HCL500MGTAB","10","Select","Select",""],["","43547035550","LISINOPRIL","30MGTABLET","90","Select","Select",""],["","555087202","MEDROXYPROGESTERONE","2.5MGTAB","90","Select","Select",""],["","42806072205","CELECOXIB","200MGCAPSULE","30","Select","Select",""],["","57237007710","ONDANSETRON","ODT4MGTABLET","24","Select","Select",""],["","69097095605","PREGABALIN","75MGCAPSULE","90","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","90","Select","Select",""],["","68180051902","LISINOPRIL-HCTZ","20-12.5MGTAB","90","Select","Select",""],["","68382003406","VENLAFAXINE","HCLER37.5MGCAP","90","Select","Select",""],["","58160081912","SHINGRIX","VIALKIT","1","Select","Select",""],["","70461032003","FLUCELVAX","QUAD2020-2021SYR","0.5","Select","Select",""],["","68382005001","MELOXICAM","7.5MGTABLET","30","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","406012310","HYDROCODONE-ACETAMIN","5-325MG","21","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":""}]}]}