{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Reginald Bryant Nelson","gend":0,"add":"1153 Old Blue Creek RD","city":"Cleveland","state":"GA","zip":30528,"dob":"1962-08-30","age":"","mstatus":"","insh":"AS1001011001","cliId":"","pno":"(706) 878-9577","cno":"","email":"","ename":"","eno":"","pphy":"JAMES MURPHEY","ppno":"","pcpadd":"4889 Golden Pkwy,Suite 10","pcpcity":"Buford","pcpstate":"GA","pcpzip":"","pcpcounty":"Buford","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":["E11.65","E11.9","E78.5","I10","D72.829","R19.5","R09.02","Z20.828","Z79.4","Z79.82","Z79.899","R06.02","I47.2","Z83.3","D12.3","R93.3","J96.01","D72.828","K57.92","Q24.9","K52.9","K76.0","E11.649","Z12.5","E78.00","Z13.6","Z13.220","Z11.59","Z68.41","K62.5","E66.01","K57.33","K57.93","Z03.818","Z09","Z12.11","R63.8","L98.9","Z00.00","B35.1"],"date":["2021-08-03","2021-08-03","2021-01-12","2021-08-03","2021-01-12","2021-03-16","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-04-27","2021-04-27","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-04-27","2021-01-06","2020-04-09","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2020-04-09","2021-08-03","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-01-19","2021-01-19","2021-08-03","2021-08-03","2020-08-04","2020-08-04"],"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":[["","597015230","JARDIANCE","10MGTABLET","30","Select","Select",""],["","16714068203","SIMVASTATIN","10MGTABLET","30","Select","Select",""],["","43547035411","LISINOPRIL","20MGTABLET","30","Select","Select",""],["","29300022701","METRONIDAZOLE","500MGTABLET","15","Select","Select",""],["","70010006505","METFORMIN","HCL1000MGTABLET","60","Select","Select",""],["","16714029904","AMOXICILLIN","500MGCAPSULE","21","Select","Select",""],["","16714065204","CIPROFLOXACIN","HCL500MGTAB","10","Select","Select",""],["","80777027315","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","45802014167","CICLOPIROX","0.08SOLUTION","6.6","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","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":""}]}]}