{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Viral Patel","gend":0,"add":"28 Edenfield Dr SE","city":"Rome","state":"GA","zip":30161,"dob":"1976-05-30","age":"","mstatus":"","insh":"AS1000532001","cliId":"","pno":7063461282,"cno":"","email":"patelwillie@yahoo.com","ename":"","eno":"","pphy":"AMAR SINGH","ppno":"","pcpadd":"1825 Martha Berry Boulevard NW","pcpcity":"Rome","pcpstate":"GA","pcpzip":"","pcpcounty":"Rome","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","Z00.01","E78.2","E11.9","I10","K21.9","E55.9","F33.1","F41.8","Z68.28","M35.01","Z13.5","E29.1","E34.8","R53.83","R73.01","Z68.29","Z71.3","Z71.89","R13.19","L81.1","Z23","J99","Z91.018","M25.521","Z20.828","B34.9","R03.0","H53.2","H60.509","R07.89","J01.80","K21.0","M77.11"],"date":["2021-08-24","2021-08-24","2021-12-28","2021-12-28","2021-08-24","2021-08-24","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-06-29","2021-06-29","2021-01-12","2020-10-27","2020-10-27","2021-05-11","2021-02-02","2021-05-11","2021-05-11","2021-12-08","2021-05-11","2021-12-08","2021-02-02","2021-02-02","2020-05-26","2020-12-15","2020-12-15","2020-12-15","2021-02-02","2020-03-03","2020-08-11","2021-01-06","2020-09-08","2020-05-26"],"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":[["","6027731","JANUVIA","100MGTABLET","30","Select","Select",""],["","70756080790","LANSOPRAZOLE","DR30MGCAPSULE","30","Select","Select",""],["","16714039102","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","65862037405","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","93830501","CIMETIDINE","800MGTABLET","30","Select","Select",""],["","16714087402","ATORVASTATIN","10MGTABLET","30","Select","Select",""],["","64380073706","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","65862085430","AMLODIPINE-OLMESARTAN","43952MG","30","Select","Select",""],["","68462043790","OLMESARTAN","MEDOXOMIL20MGTAB","30","Select","Select",""],["","70756081390","OLMESARTAN-HCTZ","40-12.5MGTAB","30","Select","Select",""],["","69097080232","TESTOSTERONE","CYP200MG\/ML","1","Select","Select",""],["","24208063562","NEOMYCIN-POLYMYXIN-HC","EARSUSP","10","Select","Select",""],["","42385090410","METFORMIN","HCL500MGTABLET","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":""}]}]}