{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maurice Thomas","gend":0,"add":"2731 Lake Towers Lane","city":"Buford","state":"GA","zip":30519,"dob":"1965-04-01","age":"","mstatus":"","insh":"AM1048365001","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"ALEXANDER OSOWA","ppno":"","pcpadd":"277 E Crogan St","pcpcity":"Lawrenceville","pcpstate":"GA","pcpzip":"","pcpcounty":"Lawrenceville","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":["I13.10","E78.2","E11.65","R53.83","G47.00","R63.5","R68.82","E53.8","E55.9","E11.21","Z68.41","L03.312","E08.621","E08.43","N18.31","E29.1","Z00.01","R06.83","R82.998","Z71.3","Z71.82","L02.222","L72.3","Z48.00","G47.33","G47.10","I10","E11.9","Z68.39","L03.90","Z01.89","E66.01","Z28.21","N18.3","R80.9","E87.1","E83.9","E87.2","N17.9","I63.9","N18.9"],"date":["2021-11-23","2021-11-23","2021-08-10","2020-04-09","2020-04-09","2020-04-09","2020-04-09","2020-04-09","2021-11-23","2021-11-23","2021-11-23","2021-08-10","2021-04-27","2021-04-27","2021-04-27","2020-05-26","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2021-07-20","2021-08-10","2021-08-10","2020-06-23","2020-06-23","2020-06-30","2020-06-23","2020-06-23","2021-07-27","2021-11-23","2021-11-23","2021-11-23","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30"],"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":[["","24587102","TOUJEO","MAXSOLOSTR300UNIT\/ML","18","Select","Select",""],["","57237010099","METOPROLOL","TARTRATE25MGTAB","180","Select","Select",""],["","93505898","ATORVASTATIN","40MGTABLET","90","Select","Select",""],["","68645059090","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","31722073190","IRBESARTAN","300MGTABLET","30","Select","Select",""],["","69238110002","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","29300013501","CLONIDINE","HCL0.1MGTABLET","180","Select","Select",""],["","169413212","OZEMPIC","0.25-0.5MGDOSEPEN","1.5","Select","Select",""],["","65862014305","CARVEDILOL","6.25MGTABLET","180","Select","Select",""],["","68645051354","NIFEDIPINE","ER60MGTABLET","30","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":""}]}]}