{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tammi Falcao","gend":1,"add":"420 Richardson Rd SE Apt 4","city":"Calhoun","state":"GA","zip":30701,"dob":"1963-05-19","age":"","mstatus":"","insh":1287624001,"cliId":"","pno":7703748743,"cno":"","email":"mstammij40@yahoo.com","ename":"","eno":"","pphy":"ELISA JARAMILLO-MAYOR","ppno":"","pcpadd":"400 Timms Road NE,N","pcpcity":"Calhoun","pcpstate":"GA","pcpzip":"","pcpcounty":"Calhoun","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":["S89.91X","M16.0","F41.8","I10","N39.46","M79.7","E66.01","R60.0","Z79.891","M79.89","M25.561","B35.4","R05.3","B34.9","M16.11","M25.551","M25.651","Z96.641","M25.761","M17.0","M25.552","M51.15","N39.41","L28.2","S80.01X","G89.11"],"date":["2021-08-24","2021-08-17","2021-08-17","2021-11-30","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-11-30","2021-05-18","2021-05-25","2021-10-12","2021-10-19","2021-10-12","2021-04-13","2021-04-06","2021-04-06","2021-05-25","2021-05-25","2021-10-12","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-09-07","2021-09-07"],"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":[["","50228014605","HYDROCHLOROTHIAZIDE","12.5MGCP","30","Select","Select",""],["","64380074208","BUSPIRONE","HCL10MGTABLET","60","Select","Select",""],["","69680011225","CYANOCOBALAMIN","1000MCG\/ML","1","Select","Select",""],["","27241009990","DULOXETINE","HCLDR60MGCAP","30","Select","Select",""],["","59762372004","ALPRAZOLAM","0.5MGTABLET","60","Select","Select",""],["","61442010310","DICLOFENAC","SODDR75MGTAB","60","Select","Select",""],["","832003850","OXYBUTYNIN","5MGTABLET","60","Select","Select",""],["","67877042905","GABAPENTIN","800MGTABLET","120","Select","Select",""],["","62991312501","NALTREXONE","HCLPOWDER","100","Select","Select",""],["","57664037713","TRAMADOL","HCL50MGTABLET","20","Select","Select",""],["","59746044790","IRBESARTAN","75MGTABLET","30","Select","Select",""],["","51672404806","CLOTRIMAZOLE-BETAMETHASONE","CRM","45","Select","Select",""],["","93314705","CEPHALEXIN","500MGCAPSULE","28","Select","Select",""],["","57237000511","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","55566410001","EUFLEXXA","20MG\/2MLSYRINGE","12","Select","Select",""],["","42799080601","IVERMECTIN","3MGTABLET","7","Select","Select",""],["","42806071405","BENZONATATE","100MGCAPSULE","42","Select","Select",""],["","27808003501","HYDROCODONE-ACETAMIN","5-325MG","12","Select","Select",""],["","42806016005","HYDROXYZINE","HCL25MGTABLET","20","Select","Select",""],["","57237007530","ONDANSETRON","HCL4MGTABLET","10","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":""}]}]}