{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ronald Chance","gend":0,"add":"803 N Duke Street","city":"LaFayette","state":"GA","zip":30728,"dob":"1957-07-06","age":"","mstatus":"","insh":"AM1050589001","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"BRYAN CHEEVER","ppno":"","pcpadd":"1012 Burleyson 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":["C44.41","R30.0","E03.9","I10","E29.1","E55.9","Z00.00","G47.33","I25.10","Z68.33","E78.5","R53.81","R53.83","D48.5","L82.0","L21.9","D22.9","D18.01","L82.1","Z85.828","I78.9","H00.015","M99.01","M99.02","M99.03","R79.89","Z95.5","E78.00","D53.1","J41.0","M54.12","H26.493","H35.033","Z96.1","M47.892","L08.9","H00.019","L85.3"],"date":["2021-12-28","2020-10-13","2021-12-28","2021-09-28","2021-12-28","2021-09-28","2021-03-23","2021-09-28","2021-09-28","2021-03-23","2020-09-08","2021-06-01","2021-06-01","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-08-03","2022-01-04","2022-01-04","2022-01-04","2020-05-12","2021-09-28","2021-09-28","2020-03-12","2020-03-12","2020-03-12","2020-10-13","2020-10-13","2020-10-13","2020-03-12","2021-12-28","2021-07-20","2020-05-19"],"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":[["","68180094111","TESTOSTERONE","0.0162GELPUMP","150","Select","Select",""],["","70377000712","ROSUVASTATIN","CALCIUM10MGTAB","90","Select","Select",""],["","378180010","LEVOTHYROXINE","25MCGTABLET","30","Select","Select",""],["","186077660","BRILINTA","60MGTABLET","180","Select","Select",""],["","186037220","SYMBICORT","80-4.5MCGINHALER","30.6","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4MGTABLETSL","25","Select","Select",""],["","65862014990","FINASTERIDE","5MGTABLET","90","Select","Select",""],["","71428000160","FLUOCINONIDE","0.0005SOLUTION","60","Select","Select",""],["","65862007701","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","45802046564","KETOCONAZOLE","0.02SHAMPOO","120","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","24208083060","NEOMYC-POLYM-DEXAMETH","EYEDROP","5","Select","Select",""],["","62756001640","TESTOSTERON","CYP2000MG\/10ML","10","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":""}]}]}