{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Glenda York","gend":1,"add":"226 Atkins Dr","city":"Cornelia","state":"GA","zip":30531,"dob":"1957-11-20","age":"","mstatus":"","insh":1505653001,"cliId":"","pno":7068093841,"cno":"","email":"glendayork1957@yahoo.com","ename":"","eno":"","pphy":"YASHBIR RANA","ppno":"","pcpadd":"541 Historic Hwy 441","pcpcity":"Demorest","pcpstate":"GA","pcpzip":"","pcpcounty":"Demorest","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":["J20.9","J44.1","J96.01","J96.02","R59.0","R79.1","E66.8","G89.29","M54.9","F32.A","Z20.822","Z68.35","Z87.891","Z86.16","Z87.01","J40","B96.29","J44.9","Z88.8","M47.816","M51.16","Z79.891","Z51.81","M53.3","F11.20","R06.02","J98.09","L03.012","M51.17","M47.27","M51.36","F06.30","F45.8","Z13.89","J02.9","R09.81","R09.02","R79.89","U07.1","J02.0","H10.31","N30.90","R91.8","R06.00","R03.0","R05.9"],"date":["2021-11-23","2021-12-28","2021-12-28","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-12-28","2021-08-24","2021-12-07","2021-09-14","2021-11-16","2021-11-16","2021-11-23","2021-11-16","2020-06-09","2021-11-23","2021-12-08","2021-11-23","2021-12-21","2021-03-02","2021-03-02","2021-03-16","2020-01-14","2020-01-14","2020-01-14","2021-08-24","2021-08-24","2021-11-30","2021-11-30","2021-11-09","2021-08-24","2021-08-24","2021-08-24","2021-09-14","2021-09-14","2021-09-02","2021-12-08"],"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":[["","93716601","CELECOXIB","200MGCAPSULE","30","Select","Select",""],["","93585201","ESCITALOPRAM","20MGTABLET","30","Select","Select",""],["","42858010450","OXYCODONE-ACETAMINOPHEN","10-325","110","Select","Select",""],["","378932132","WIXELA","250-50INHUB","60","Select","Select",""],["","72205001390","PREGABALIN","75MGCAPSULE","90","Select","Select",""],["","42806034805","BUPROPION","HCLXL150MGTABLET","30","Select","Select",""],["","93031401","KETOROLAC","10MGTABLET","12","Select","Select",""],["","55111028130","LEVOFLOXACIN","750MGTABLET","10","Select","Select",""],["","68462018022","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","65862019999","GABAPENTIN","300MGCAPSULE","180","Select","Select",""],["","65862018730","ONDANSETRON","HCL4MGTABLET","12","Select","Select",""],["","61314062810","POLYMYXIN","B-TMPEYEDROPS","10","Select","Select",""],["","54001825","PREDNISONE","20MGTABLET","10","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","68180096301","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","54418625","DEXAMETHASONE","6MGTABLET","10","Select","Select",""],["","55111012705","CIPROFLOXACIN","HCL500MGTAB","20","Select","Select",""],["","406012310","HYDROCODONE-ACETAMIN","5-325MG","14","Select","Select",""],["","597010061","SPIRIVA","RESPIMAT2.5MCGINH","4","Select","Select",""],["","42192080101","PHENAZOPYRIDINE","100MGTAB","15","Select","Select",""],["","378104901","DOXEPIN","10MGCAPSULE","30","Select","Select",""],["","69238110005","DOXYCYCLINE","HYCLATE100MGCAP","20","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":""}]}]}