{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan M Rann","gend":1,"add":"800 Brent Lane","city":"Dalton","state":"GA","zip":30720,"dob":"1969-10-06","age":"","mstatus":"","insh":"AS1004300001","cliId":"","pno":7062770713,"cno":"","email":"smrann04@gmail.com","ename":"","eno":"","pphy":"Megan Brown","ppno":"","pcpadd":"800 GI Maddox Pkwy","pcpcity":"Chatsworth","pcpstate":"GA","pcpzip":"","pcpcounty":"Chatsworth","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":["G43.909","R11.2","M54.50","J01.80","E78.5","Z79.899","E03.9","D51.0","E53.8","N30.00","R30.0","M54.41","Z68.31","G43.711","Z20.822","H65.03","J01.90","M54.31","M54.32","B37.2"],"date":["2021-05-25","2021-02-16","2021-11-30","2021-11-30","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-11-02","2021-11-02","2021-03-02","2021-03-02","2021-10-19","2021-08-31","2021-08-31","2021-08-31","2021-08-03","2021-04-27","2021-07-06"],"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":[["","527155201","BUTALBITAL-ASA-CAFFEINE","CAP","30","Select","Select",""],["","69315030630","NYSTATIN","100000UNIT\/GMPOWD","30","Select","Select",""],["","59651000305","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","16729044316","BUPROPION","HCLXL150MGTABLET","30","Select","Select",""],["","68382020405","GABAPENTIN","600MGTABLET","30","Select","Select",""],["","16729017217","AMITRIPTYLINE","HCL25MGTAB","30","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","143962125","CYANOCOBALAMIN","1000MCG\/MLVL","1","Select","Select",""],["","16729044917","LEVOTHYROXINE","75MCGTABLET","30","Select","Select",""],["","72618300002","NURTEC","ODT75MGTABLET","8","Select","Select",""],["","68462026005","VERAPAMIL","ER240MGTABLET","30","Select","Select",""],["","27808015501","ROSUVASTATIN","CALCIUM5MGTAB","30","Select","Select",""],["","23650110","UBRELVY","100MGTABLET","10","Select","Select",""],["","603459315","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","55111017910","TIZANIDINE","HCL2MGTABLET","30","Select","Select",""],["","29300012510","MELOXICAM","15MGTABLET","30","Select","Select",""],["","51672128201","TRIAMCINOLONE","0.001CREAM","45","Select","Select",""],["","68001025320","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","68001042300","NITROFURANTOIN","MONO-MCR100MG","10","Select","Select",""],["","68001036206","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","54629012800","FOLIC","ACID1000MCGTABLET","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":""}]}]}