{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James Kelley","gend":0,"add":"20 Huntington Rd SW","city":"Rome","state":"GA","zip":30165,"dob":"1956-01-01","age":"","mstatus":"","insh":"AM1049070001","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Wilma Briones Mull","ppno":"","pcpadd":"1328 Joe Frank Harris Parkway SE","pcpcity":"Cartersville","pcpstate":"GA","pcpzip":"","pcpcounty":"Cartersville","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":["E78.2","R73.01","I10","M15.0","E34.8","Z68.35","C44.519","D22.9","L82.1","L57.0","Z00.00","Z00.01","E29.1","K75.81","E66.8","Z71.3","Z71.89","Z23","E11.9","R89.0","H90.11","Z68.32","J30.2","Z12.5","C44.612","Z20.828","S91.009","M25.572","L03.115","M17.11","K52.9","U07.1","J00","H92.01","H68.011","R42","R05","J06.9","B97.89"],"date":["2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-11-23","2021-12-16","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-11-09","2021-11-09","2021-11-09","2021-12-16","2021-11-09","2021-12-16","2021-12-16","2021-11-09","2020-10-13","2021-01-26","2021-12-28","2021-08-24","2021-12-16","2021-12-16","2021-05-25","2020-12-29","2021-02-09","2021-02-09","2020-09-08","2021-04-06","2021-11-09","2021-07-20","2021-07-20","2021-12-28","2021-12-28","2021-08-24","2020-03-03","2020-03-03","2020-03-03"],"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":[["","64380073406","HYDRALAZINE","25MGTABLET","60","Select","Select",""],["","68001036105","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","62175011937","ISOSORBIDE","MONONITER60MGTB","180","Select","Select",""],["","93314705","CEPHALEXIN","500MGCAPSULE","30","Select","Select",""],["","65862090801","CELECOXIB","100MGCAPSULE","60","Select","Select",""],["","93753656","ANASTROZOLE","1MGTABLET","30","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25MGTAB","90","Select","Select",""],["","406123601","DIPHENOXYLATE-ATROP","2.5-0.025","30","Select","Select",""],["","53746051401","SPIRONOLACTONE","50MGTABLET","45","Select","Select",""],["","69238126601","OSELTAMIVIR","PHOS75MGCAPSULE","10","Select","Select",""],["","13668042990","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","68462016505","CARVEDILOL","25MGTABLET","180","Select","Select",""],["","42192033901","HYOSCYAMINE","0.125MGTABSL","20","Select","Select",""],["","60505083305","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","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":""}]}]}