{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Teresa C Turpin","gend":1,"add":"262 River Run Rd","city":"Lula","state":"GA","zip":30554,"dob":"1959-08-09","age":"","mstatus":"","insh":1427967001,"cliId":"","pno":7066772458,"cno":"","email":"tcturpin99@windstream.net","ename":"","eno":"","pphy":"Erin London","ppno":"","pcpadd":"415 Pottery Factory Dr","pcpcity":"Commerce","pcpstate":"GA","pcpzip":"","pcpcounty":"Commerce","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":["Z79.01","D47.2","E61.1","R77.8","D50.9","D64.9","N81.10","Z00.00","E11.9","Z23","N93.9","I10","M19.90","J45.909","J18.9","E11.65","J96.01","J45.21","I48.0","I11.0","Z68.45","R05","R09.81","J06.9","L02.211","R06.02","R06.00","K91.2","E87.70","G47.33","E66.01","K52.9","G25.81","I27.20","Z20.822","Z86.711","Z86.718","Z79.84","E87.2","J45.901","F33.0","E66.2","I82.509","E11.22","N18.30","I12.9","F41.9","Z79.4","S39.91X","S39.93X","J45.998","F32.9","E78.2","I49.3","B36.9","Z83.3","Z82.49","Z82.3","Z80.41","Z80.0","Z88.5","R60.0","Z86.79","Z86.39","R11.0","D50.8","J01.80","J20.8","R06.2","G62.89","J02.0","H65.03","Z20.828","J45.20","N18.31","Z99.89","G47.00","R63.8","Z13.31","I82.722","J01.90","E87.1","E83.42","M25.50","R53.1","R93.89","R68.83","Z83.49","N17.9","F32.A","M54.5","R10.32","R31.29","N95.0","G44.83","J96.90","R65.10","Z12.31","I50.33","I48.20","I50.32","E66.9","R07.0","J30.89","Z79.899","R10.9","F41.1","K90.9","K57.93","G47.09","Z20.818","I48.91","Z51.81","N32.81","G89.29","H25.13","H04.123","H52.13","R82.998","J81.1","I50.9","R94.4","J90","R05.9","Z09","B37.9","I35.0","I82.91","J98.4","Z12.4","I13.0"],"date":["2021-12-21","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-03-30","2021-12-28","2021-10-19","2020-10-13","2021-12-28","2021-04-13","2021-12-14","2021-12-28","2021-12-21","2021-12-28","2021-12-21","2021-12-28","2021-12-21","2021-12-21","2021-09-21","2020-02-18","2020-02-18","2020-02-18","2021-10-06","2021-09-28","2021-05-25","2021-05-25","2021-12-21","2021-12-21","2021-05-25","2021-12-21","2021-05-25","2021-12-21","2021-12-21","2021-09-22","2021-09-14","2021-10-06","2021-12-21","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2020-10-13","2020-10-13","2021-10-05","2021-10-05","2021-12-16","2021-10-05","2021-10-05","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-10-05","2021-03-16","2021-03-16","2021-03-16","2021-04-13","2021-02-11","2021-05-11","2021-08-24","2021-08-24","2021-10-06","2021-03-16","2021-03-16","2021-05-25","2021-09-14","2021-09-14","2021-09-28","2021-02-11","2021-02-11","2020-11-03","2020-11-03","2020-11-03","2021-05-18","2021-05-18","2021-04-13","2021-05-18","2021-04-13","2021-04-13","2021-04-13","2021-12-28","2021-12-21","2020-06-30","2020-06-30","2020-06-30","2020-10-13","2021-08-24","2021-10-06","2021-10-06","2021-11-18","2021-10-13","2021-12-16","2021-12-28","2021-09-28","2020-01-21","2020-01-21","2021-09-22","2020-10-13","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2021-11-23","2021-10-05","2021-02-23","2020-07-14","2020-07-14","2020-01-21","2020-01-21","2020-01-21","2020-07-07","2021-12-08","2021-10-26","2021-12-08","2021-12-08","2021-12-14","2021-09-21","2021-09-21","2021-09-14","2021-09-14","2021-12-08","2020-11-24","2021-09-22"],"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":[["","93314705","CEPHALEXIN","500MGCAPSULE","30","Select","Select",""],["","228282011","HYDROCHLOROTHIAZIDE","12.5MGTB","22","Select","Select",""],["","51672403203","WARFARIN","SODIUM5MGTABLET","56","Select","Select",""],["","62332003231","ROPINIROLE","HCL1MGTABLET","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MGTABLET","30","Select","Select",""],["","55111046605","METOPROLOL","SUCCER25MGTAB","23","Select","Select",""],["","65862000899","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","70377002713","ATORVASTATIN","10MGTABLET","30","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","27241005103","ARIPIPRAZOLE","2MGTABLET","30","Select","Select",""],["","68462010340","FLUCONAZOLE","150MGTABLET","2","Select","Select",""],["","68180072103","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","469260130","MYRBETRIQ","ER25MGTABLET","30","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","60","Select","Select",""],["","13668000701","ZOLPIDEM","TARTRATE5MGTABLET","30","Select","Select",""],["","70069000510","CYANOCOBALAMIN","1000MCG\/ML","1","Select","Select",""],["","904759180","FERROUS","SULFATE325MGTABLET","30","Select","Select",""],["","68180071160","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","76204020060","ALBUTEROL","SUL2.5MG\/3MLSOLN","360","Select","Select",""],["","8627001601","DEXCOM","G6TRANSMITTER","1","Select","Select",""],["","16729022516","SPIRONOLACTONE","25MGTABLET","30","Select","Select",""],["","31722053101","TORSEMIDE","20MGTABLET","30","Select","Select",""],["","68001045608","ESCITALOPRAM","20MGTABLET","30","Select","Select",""],["","65862073205","AMIODARONE","HCL200MGTABLET","30","Select","Select",""],["","591544210","PREDNISONE","10MGTABLET","23","Select","Select",""],["","70436015301","POTASSIUM","CLER20MEQTABLET","30","Select","Select",""],["","2879959","HUMALOG","100UNIT\/MLKWIKPEN","21","Select","Select",""],["","54414622","CLOTRIMAZOLE","10MGTROCHE","50","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","24979002707","DILTIAZEM","24HER(CD)180MGCP","60","Select","Select",""],["","169413212","OZEMPIC","0.25-0.5MG\/DOSEPEN","1.5","Select","Select",""],["","78077720","ENTRESTO","49MG-51MGTABLET","60","Select","Select",""],["","52817032110","BACLOFEN","20MGTABLET","60","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","28","Select","Select",""],["","31722095801","BENZONATATE","200MGCAPSULE","30","Select","Select",""],["","70710101002","OSELTAMIVIR","PHOS75MGCAPSULE","10","Select","Select",""],["","31722052001","HYDRALAZINE","25MGTABLET","90","Select","Select",""],["","228299650","TAMSULOSIN","HCL0.4MGCAPSULE","14","Select","Select",""],["","45802058084","SCOPOLAMINE","1MG\/3DAYPATCH","3","Select","Select",""],["","65862007701","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","47335070649","IPRATROPIUM","BR0.0002SOLN","250","Select","Select",""],["","310621030","FARXIGA","10MGTABLET","30","Select","Select",""],["","69315011710","FUROSEMIDE","40MGTABLET","30","Select","Select",""],["","406012301","HYDROCODONE-ACETAMIN","5-325MG","20","Select","Select",""],["","88221905","LANTUS","SOLOSTAR100UNIT\/ML","27","Select","Select",""],["","173088210","BREO","ELLIPTA200-25MCGINH","60","Select","Select",""],["","65862018601","CLINDAMYCIN","HCL300MGCAPSULE","30","Select","Select",""],["","68462018022","MUPIROCIN","0.02OINTMENT","66","Select","Select",""],["","8290328203","BD","UFORIGPENNDL12.7MMX29G","100","Select","Select",""],["","59267100002","PFIZER","COVID-19VACCINE(EUA)","0.3","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":""}]}]}