{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Emelda F Avila","gend":1,"add":"3703 Garden Lakes Pkwy NW","city":"Rome","state":"GA","zip":30165,"dob":"1949-03-14","age":"","mstatus":"","insh":1462317001,"cliId":"","pno":6788954786,"cno":"","email":"emeldaavila2019@gmail.com","ename":"","eno":"","pphy":"EDWARD MEIER","ppno":"","pcpadd":"424 N Main St,Polk Medical Ct","pcpcity":"Cedartown","pcpstate":"GA","pcpzip":"","pcpcounty":"Cedartown","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":["R10.11","N64.89","R92.2","Z00.00","Z00.01","R53.83","H35.371","H40.033","H25.13","I87.2","M54.50","M54.9","Z86.19","H65.03","B37.0","B37.81","R10.0","Z11.59","U07.1","S39.012","M46.00","R13.19","R07.89","E78.5","M35.01","M54.5","M25.551","Z23","J06.9","I12.9","R80.9","M47.896","M54.6","J98.11","K21.9","E08.9","Z79.899","M35.00","R03.0","L85.3","M25.50","K59.09","E66.3","Z68.27","N81.10","R07.9","M79.605","Z09","R31.9","L23.7","H35.373","M51.36","M43.16","M51.34","M47.814","E78.2","R30.9","N95.1","N39.46","E55.9","N60.19","N64.4","M48.02","M47.816","M15.9","R10.13","R09.89","N63.0","J30.9","J02.9","M46.46","I83.893","M50.30","K22.2","K64.8","M54.16","M54.81","F41.1","J01.00"],"date":["2020-06-30","2020-12-29","2020-12-29","2021-10-06","2021-10-06","2021-10-06","2021-10-26","2021-10-26","2021-10-26","2020-08-11","2021-12-16","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-08-11","2020-08-04","2020-10-27","2021-04-13","2021-04-13","2021-02-02","2020-12-29","2021-05-04","2021-05-04","2021-05-04","2020-04-09","2021-10-13","2020-04-09","2021-10-13","2021-10-13","2021-10-20","2021-10-13","2021-01-12","2021-08-24","2020-11-03","2021-08-24","2021-09-07","2021-08-24","2021-08-24","2021-08-24","2021-09-07","2021-08-24","2021-08-24","2020-08-18","2021-02-16","2020-02-25","2020-02-25","2021-12-07","2021-07-13","2021-10-14","2021-11-30","2021-10-20","2021-10-20","2021-11-30","2021-05-04","2021-10-20","2020-01-14","2020-01-14","2021-02-02","2020-11-17","2020-11-17","2021-11-02","2021-11-30","2021-09-07","2020-12-15","2021-02-02","2020-12-22","2020-05-19","2020-05-19","2021-12-07","2020-03-12","2021-12-14","2021-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2021-04-06"],"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":[["","42571014401","CELECOXIB","200MGCAPSULE","30","Select","Select",""],["","115151866","ESTRADIOL","0.0001CREAM","42.5","Select","Select",""],["","68645049254","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","173068220","VENTOLIN","HFA90MCGINHALER","18","Select","Select",""],["","5197102","PREVNAR","13SYRINGE","0.5","Select","Select",""],["","66689000816","NYSTATIN","100000UNIT\/MLSUSP","200","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","93083205","CLONAZEPAM","0.5MGTABLET","30","Select","Select",""],["","228280111","PILOCARPINE","HCL5MGTABLET","90","Select","Select",""],["","67877019805","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","69452014430","BENZONATATE","200MGCAPSULE","20","Select","Select",""],["","66993001968","ALBUTEROL","HFA90MCGINHALER","18","Select","Select",""],["","49281012065","FLUZONE","HIGH-DOSEQUAD2020-21","0.7","Select","Select",""],["","65162019050","NAPROXEN","500MGTABLET","60","Select","Select",""],["","69238153205","CLOBETASOL","0.0005CREAM","30","Select","Select",""],["","713050324","ANUCORT-HC","25MGSUPPOSITORY","28","Select","Select",""],["","172572970","FAMOTIDINE","40MGTABLET","30","Select","Select",""],["","70010077001","METHOCARBAMOL","750MGTABLET","30","Select","Select",""],["","29300013501","CLONIDINE","HCL0.1MGTABLET","2","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","45802006435","TRIAMCINOLONE","0.001CREAM","15","Select","Select",""],["","67877022310","GABAPENTIN","300MGCAPSULE","30","Select","Select",""],["","43547028010","ESCITALOPRAM","5MGTABLET","30","Select","Select",""],["","378064110","PREDNISONE","10MGTABLET","28","Select","Select",""],["","6483703","PNEUMOVAX","23SYRINGE","0.5","Select","Select",""],["","527128201","DICYCLOMINE","20MGTABLET","20","Select","Select",""],["","70710113908","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","68645054459","METFORMIN","HCL500MGTABLET","30","Select","Select",""],["","16714008210","HYDROXYZINE","HCL25MGTABLET","15","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":""}]}]}