{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Blanca R Solorzano","gend":1,"add":"150 Chandlers Rdg","city":"Chatsworth","state":"GA","zip":30705,"dob":"1971-05-13","age":"","mstatus":"","insh":1320382001,"cliId":"","pno":7062185889,"cno":"","email":"asolorzan9691@bryan.edu","ename":"","eno":"","pphy":"PABLO PEREZ","ppno":"","pcpadd":"1102 W Waugh St","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":["L23.7","F41.1","M05.49","E88.81","M19.012","M25.512","E66.9","J30.1","M54.5","Z00.01","G56.01","F32.0","Z13.1","L23.9","M79.641","K21.9","M25.50","Z79.1","M25.549","M25.579","M70.61","M25.561","M54.89","M79.18","L71.9","M17.0","M15.0","E01.0","E04.1","E04.9","Z23","R07.9","M54.12","R20.0","M15.9","N39.0","E78.2","L25.9","L29.9","Z20.828","Z71.89","L20.89","R07.89","L71.8","G56.02","M79.671","M25.571","M75.101","M75.102","R19.7","R14.0","Z12.31","L30.9","J30.89","M47.22","R20.2","E01.1","E07.89","Z09","Z87.2","L03.011"],"date":["2020-03-12","2020-12-08","2020-09-01","2021-08-24","2021-06-15","2021-06-15","2021-06-15","2020-05-12","2021-05-04","2021-08-05","2021-03-23","2021-08-24","2021-03-09","2020-10-27","2021-03-09","2021-03-09","2021-11-02","2021-11-02","2021-07-27","2021-07-27","2021-12-07","2021-12-07","2020-09-22","2021-05-04","2020-05-05","2021-11-02","2021-11-02","2021-09-01","2021-01-12","2020-12-08","2021-04-20","2020-09-22","2021-05-04","2021-05-04","2021-08-24","2021-08-24","2021-08-24","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-03-10","2020-09-29","2020-07-28","2021-03-23","2021-03-23","2021-03-23","2021-06-01","2021-06-01","2020-09-29","2020-09-29","2021-04-27","2020-05-19","2020-05-19","2021-05-25","2021-05-04","2021-07-27","2021-07-27","2020-06-16","2020-06-16","2020-06-16"],"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":[["","299598035","MIRVASO","0.0033GELPUMP","30","Select","Select",""],["","10702000709","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","72143021160","DOXYCYCLINE","50MGTABLET","30","Select","Select",""],["","66993096045","METRONIDAZOLE","0.0075CREAM","45","Select","Select",""],["","67877022310","GABAPENTIN","300MGCAPSULE","30","Select","Select",""],["","65862029490","ROSUVASTATIN","CALCIUM10MGTAB","30","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","57237001830","DULOXETINE","HCLDR30MGCAP","7","Select","Select",""],["","50228046501","NABUMETONE","500MGTABLET","60","Select","Select",""],["","16714008210","HYDROXYZINE","HCL25MGTABLET","30","Select","Select",""],["","45802006436","TRIAMCINOLONE","0.001CREAM","80","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","58160082311","SHINGRIX","VIALKIT","1","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","13668048450","MINOCYCLINE","100MGCAPSULE","60","Select","Select",""],["","65162019011","NAPROXEN","500MGTABLET","60","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.2","Select","Select",""],["","16729017217","AMITRIPTYLINE","HCL25MGTAB","30","Select","Select",""],["","67877021905","CEPHALEXIN","500MGCAPSULE","28","Select","Select",""],["","31722071390","PANTOPRAZOLE","SODDR40MGTAB","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":""}]}]}