{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William R Edge","gend":0,"add":"5401 Stone Trace","city":"Gainesville","state":"GA","zip":30504,"dob":"1960-08-25","age":"","mstatus":"","insh":"AM0040653001","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"KELLY O'DELL","ppno":"","pcpadd":"4222 Fairbanks Dr","pcpcity":"Oakwood","pcpstate":"GA","pcpzip":"","pcpcounty":"Oakwood","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":["Z00.00","E78.2","I25.10","E29.1","Z11.59","I10","M25.50","R51.9","K21.9","F41.0","Z12.5","J45.40","M50.30","G44.209","M79.18","J20.9","R09.82","R06.2","R05","G56.02","G47.33","Z68.36","R51","R19.7","R11.0","Z20.828","Z68.35","R20.0","R20.2","J01.10","Z68.34","M47.22","I25.119","R07.89","Z68.33","Z13.89","J45.998","J40","M54.2","G89.29","Z20.822","U07.1","R06.83"],"date":["2021-01-12","2021-09-21","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-09-21","2021-01-12","2021-01-12","2021-12-07","2021-12-07","2021-12-07","2020-03-24","2020-03-24","2020-03-31","2020-03-24","2020-06-23","2020-06-23","2020-06-23","2020-10-20","2020-09-29","2020-09-29","2021-09-28","2021-11-16","2021-11-16","2021-09-21","2020-08-11","2021-09-21","2021-11-16","2021-09-21","2021-10-26","2021-09-21","2021-01-12","2020-03-31","2020-03-31","2021-11-16","2021-11-16","2021-09-21","2021-01-19","2020-09-15"],"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":[["","186037020","SYMBICORT","160-4.5MCGINHALER","10.2","Select","Select",""],["","173085910","BREO","ELLIPTA100-25MCGINH","60","Select","Select",""],["","832105410","BACLOFEN","10MGTABLET","30","Select","Select",""],["","55111029236","SUMATRIPTAN","SUCC50MGTABLET","9","Select","Select",""],["","11534018701","BUTALB-ACETAMIN-CAFF","50-300-40","15","Select","Select",""],["","69097083412","SERTRALINE","HCL50MGTABLET","90","Select","Select",""],["","93720198","PRAVASTATIN","SODIUM20MGTAB","90","Select","Select",""],["","31722070290","LOSARTAN","POTASSIUM100MGTAB","90","Select","Select",""],["","65862035790","CLOPIDOGREL","75MGTABLET","90","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","60","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","90","Select","Select",""],["","143965901","TESTOSTERONE","CYP200MG\/ML","2","Select","Select",""],["","67877032105","IBUPROFEN","800MGTABLET","21","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","69097012203","TOPIRAMATE","25MGTABLET","90","Select","Select",""],["","50228042360","RANOLAZINE","ER500MGTABLET","180","Select","Select",""],["","69097015807","MELOXICAM","7.5MGTABLET","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","68180071160","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","781801731","FLUVASTATIN","ER80MGTABLET","30","Select","Select",""],["","456140530","BYSTOLIC","5MGTABLET","180","Select","Select",""],["","603533815","PREDNISONE","10MGTABDOSEPACK","21","Select","Select",""],["","68180016013","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","53489011905","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","70377002911","ATORVASTATIN","40MGTABLET","90","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":""}]}]}