{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George F Dollar","gend":0,"add":"279 Corinth Church Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"1956-12-16","age":"","mstatus":"","insh":"AS1002646001","cliId":"","pno":7062731618,"cno":"","email":"frank@gfddesign.com","ename":"","eno":"","pphy":"ANIL YADAV","ppno":"","pcpadd":"51 Gordon Road,Suite 20","pcpcity":"Jasper","pcpstate":"GA","pcpzip":"","pcpcounty":"Jasper","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":["M54.32","M54.5","H90.42","H92.02","F51.01","H91.92","I10","I25.10","R73.09","Z00.00","R22.32","Z23","I49.3","I11.9","E78.49","Z72.0","R00.2","Z12.5","K52.9","F33.2","F41.9","F17.200","G50.0","F17.219","R19.7","Z68.24"],"date":["2020-06-23","2020-04-09","2021-09-14","2021-09-14","2021-08-17","2021-08-17","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-10-20","2021-10-20","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-03-17","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2020-03-17","2020-07-21","2020-01-14","2020-01-28"],"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":[["","378395205","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","69543013611","TRAMADOL","HCL50MGTABLET","60","Select","Select",""],["","13107004501","OXYCODON-ACETAMINOPHEN","7.5-325","90","Select","Select",""],["","55111046601","METOPROLOL","SUCCER25MGTAB","60","Select","Select",""],["","69097014260","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","180","Select","Select",""],["","68180029506","DULOXETINE","HCLDR30MGCAP","30","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","16571020150","DICLOFENAC","SODEC75MGTAB","60","Select","Select",""],["","33332032001","AFLURIA","QUAD2020-21(3YRUP)","0.5","Select","Select",""],["","406051205","OXYCODONE-ACETAMINOPHEN","5-325","90","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":""}]}]}