{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jillian B Cheever","gend":1,"add":"1705 Westchester Drive","city":"Dalton","state":"GA","zip":30720,"dob":"1996-01-24","age":"","mstatus":"","insh":"AS1005004003","cliId":"","pno":"","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":["Z01.419","Z13.31","B37.3","F33.1","F90.0","G47.09","H00.14","H00.025","F41.8","F90.9","J45.909","Z23"],"date":["2021-03-16","2021-03-16","2021-03-16","2021-04-27","2021-04-27","2021-04-27","2021-07-06","2021-04-27","2021-11-02","2021-11-02","2021-11-02","2021-11-02"],"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":[["","60505083305","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","57237000511","FLUCONAZOLE","150MGTABLET","3","Select","Select",""],["","23155013525","DOXYCYCLINE","MONO100MGTABLET","20","Select","Select",""],["","60505083001","MOMETASONE","FUROATE50MCGSPRY","17","Select","Select",""],["","65862017760","CEFDINIR","300MGCAPSULE","14","Select","Select",""],["","378427677","VALACYCLOVIR","HCL1GRAMTABLET","30","Select","Select",""],["","61314063006","NEOMYC-POLYM-DEXAMETH","EYEDROP","5","Select","Select",""],["","65862001305","SERTRALINE","HCL100MGTABLET","30","Select","Select",""],["","59417010310","VYVANSE","30MGCAPSULE","30","Select","Select",""],["","52817033010","CYCLOBENZAPRINE","5MGTABLET","42","Select","Select",""],["","143992801","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","72647033104","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","60505265301","TRAZODONE","50MGTABLET","30","Select","Select",""],["","61314062810","POLYMYXIN","B-TMPEYEDROPS","10","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","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":""}]}]}