{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anthony J Karpinski","gend":0,"add":"453 Garrett Rd","city":"Demorest","state":"GA","zip":30535,"dob":"1959-08-08","age":"","mstatus":"","insh":1080573001,"cliId":"","pno":7067683679,"cno":"","email":"anthonykarpinski@cheechytees.com","ename":"","eno":"","pphy":"Todd Bethea","ppno":"","pcpadd":"108 Prominence Ct,Suite 10","pcpcity":"Dawsonville","pcpstate":"GA","pcpzip":"","pcpcounty":"Dawsonville","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":["N13.2","N28.89","K40.90","Z03.818","J20.9","R05","N20.0","N23","I10","I50.32","E78.2","Z11.59","R10.9","R11.0","I25.10","E78.5","I25.2","F17.210","R23.8","N39.0","R31.9","R11.2","E86.0","E80.7","E78.00","Z87.442","Z79.01","I11.9","R10.30","N13.9","M25.572","W19.XXX","M79.672","S99.922","Z79.899","I11.0","R06.00","Z68.27","R63.8","Z87.891","M54.16","M51.36","M17.10","I25.118","E78.49","S99.912","I73.9"],"date":["2020-09-15","2020-09-15","2020-09-15","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-09-15","2021-11-09","2020-12-01","2020-12-01","2020-04-09","2020-09-15","2020-09-15","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2020-07-21","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2021-11-09","2020-09-15","2021-06-29","2020-10-06","2020-10-06","2021-11-09","2021-11-09","2021-11-09","2021-11-23","2021-11-09","2020-01-14","2020-01-14","2020-12-01","2020-12-01","2020-12-01","2021-03-09","2021-03-09","2021-03-09","2021-06-29","2021-06-29","2021-11-23","2020-12-01"],"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":[["","47335089413","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","68645049554","ATORVASTATIN","80MGTABLET","30","Select","Select",""],["","62037059790","CARTIA","XT120MGCAPSULE","30","Select","Select",""],["","50742061510","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","68645055254","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","68682099398","DILTIAZEM","24HER(CD)120MGCP","30","Select","Select",""],["","67877045005","TAMSULOSIN","HCL0.4MGCAPSULE","10","Select","Select",""],["","67877021560","CEFUROXIME","AXETIL250MGTAB","20","Select","Select",""],["","69543038810","KETOROLAC","10MGTABLET","10","Select","Select",""],["","55111015330","ONDANSETRON","HCL4MGTABLET","10","Select","Select",""],["","69238110005","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","42858010201","OXYCODONE-ACETAMINOPHEN","5-325","15","Select","Select",""],["","60432060416","PROMETHAZINE-DM","SYRUP","118","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4MGTABLETSL","25","Select","Select",""],["","80777027398","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","16571020210","DICLOFENAC","SODEC50MGTAB","8","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":""}]}]}