{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anne Barker","gend":1,"add":"4205 Country Way","city":"Cohutta","state":"GA","zip":30710,"dob":"1966-08-04","age":"","mstatus":"","insh":"AS1000742005","cliId":"","pno":"(706) 278-2429","cno":"","email":"","ename":"","eno":"","pphy":"Stephen Tidwell","ppno":"","pcpadd":"1250 Broadrick Dr","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":["K51.50","K51.30","I51.7","R00.2","I49.3","K51.90","H25.12","K58.1","E55.9","Z12.31","I36.1","Z13.6","N95.9","Z01.419","H25.11","M85.80","N95.8","N95.2","R53.83","E53.8","R74.01","Z79.52","J98.11","R30.9","Z20.822","Z98.890","H25.13","H52.223","H35.372","F42.4","Z13.29","Z13.31","N94.10","R68.83","H43.813","H25.813","K51.80","D51.8","K52.9","K64.8","M85.89","R94.31","I42.0","I50.30","I77.810","Z23","H61.23","H93.293","H26.493","H04.123","R00.1","I49.1","N95.1","R39.15","K21.9"],"date":["2021-12-21","2022-01-04","2021-10-20","2021-08-24","2021-10-12","2021-10-12","2020-12-01","2020-10-27","2021-05-25","2021-11-30","2021-08-03","2021-08-03","2021-11-23","2021-09-28","2020-12-15","2020-12-01","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-10-27","2021-11-18","2021-12-14","2021-11-30","2021-12-28","2021-12-21","2020-12-01","2020-12-01","2020-12-01","2020-10-13","2021-09-21","2021-09-21","2021-10-12","2021-12-28","2020-07-14","2020-07-14","2021-05-25","2021-05-25","2021-12-14","2021-12-14","2020-09-29","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-09-28","2021-10-26","2020-02-11","2021-04-06","2021-05-11","2021-06-08","2021-06-08","2021-12-21","2021-12-21","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":[["","68462018022","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","59630058090","OSPHENA","60MGTABLET","30","Select","Select",""],["","47781030301","NITROFURANTOIN","MONO-MCR100MG","10","Select","Select",""],["","57237000511","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","469260130","MYRBETRIQ","ER25MGTABLET","30","Select","Select",""],["","69076091302","MERCAPTOPURINE","50MGTABLET","30","Select","Select",""],["","55566670001","CLENPIQ","SOLUTION","320","Select","Select",""],["","43386002606","FLUOCINONIDE","0.0005SOLUTION","60","Select","Select",""],["","115165901","PROPRANOLOL","10MGTABLET","30","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","93031801","DILTIAZEM","30MGTABLET","60","Select","Select",""],["","37682210","PROCTOFOAM-HC","1%-1%FOAM","10","Select","Select",""],["","69367016304","PHENAZOPYRIDINE","200MGTAB","10","Select","Select",""],["","16714073301","CELECOXIB","200MGCAPSULE","60","Select","Select",""],["","33332042010","AFLURIA","QUAD2020-2021VIAL","0.5","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":""}]}]}