{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karen Collins","gend":1,"add":"703 Pine Lake Drive","city":"Sparta","state":"GA","zip":31087,"dob":"1968-05-17","age":"","mstatus":"","insh":"AS1004898001","cliId":"","pno":7703655193,"cno":"","email":"","ename":"","eno":"","pphy":"MICHAEL DUKE","ppno":"","pcpadd":"540 W Thomas St,Suite ","pcpcity":"Milledgeville","pcpstate":"GA","pcpzip":"","pcpcounty":"Milledgeville","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":["D72.829","Z20.828","Z03.818","D25.9","Z88.0","Z88.8","L81.4","Z23","K50.90","F41.9","J30.9","D51.9","Z00.01","K50.80","K92.1","Z98.0","K50.111","L57.0","N95.1","K50.10","K50.012","Z68.20","Z12.31","J20.9","R10.30","K62.5","K59.39","N83.8","Z87.19"],"date":["2021-02-11","2021-06-01","2021-06-01","2021-05-25","2021-05-25","2021-05-25","2021-08-24","2021-04-27","2021-08-10","2021-08-10","2021-08-10","2021-05-04","2021-05-04","2021-02-11","2021-10-26","2021-02-11","2021-03-30","2021-05-04","2021-08-10","2021-06-29","2021-10-26","2021-10-26","2021-05-25","2021-11-23","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11"],"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":[["","65862093488","AUROVELA","24FE1MG-20MCGTAB","28","Select","Select",""],["","13668013610","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","68382061928","COLESEVELAM","625MGTABLET","60","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","70069017210","CYANOCOBALAMIN","1000MCG\/ML","10","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","68462073129","HAILEY","24FE1MG-20MCGTAB","28","Select","Select",""],["","49884072703","DOXYCYCLINE","MONO100MGCAP","20","Select","Select",""],["","378668999","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","121077516","GUAIFENESIN-CODEINE","SYRUP","100","Select","Select",""],["","591544210","PREDNISONE","10MGTABLET","70","Select","Select",""],["","49281042150","FLUZONE","QUAD2021-2022SYRINGE","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":""}]}]}