{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Harvey L Gunter","gend":0,"add":"302 Lake Laurel Dr","city":"Dahlonega","state":"GA","zip":30533,"dob":"1962-09-21","age":"","mstatus":"","insh":1532145002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Kimberly Kurtz","ppno":"","pcpadd":"1300 S Chestatee","pcpcity":"Dahlonega","pcpstate":"GA","pcpzip":"","pcpcounty":"Dahlonega","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":["M43.16","M96.1","M17.11","F11.20","Z79.891","M54.9","M79.604","G97.41","M48.061","G89.29","M51.16","E10.9","E78.5","I10","E29.1","Z51.81","E11.65","E11.22","I12.9","N18.9","R00.1","I25.10","Z95.5","R00.2","I49.1","E13.9","R63.8","I21.02","Z68.26","Z00.00","Z12.5","R10.13","R07.9","R19.7","R11.0","Z12.11","Z28.20","E11.9","J30.9","M51.36","E78.49","Z68.27","M17.0","R07.2","Z98.1","M43.26","Z01.818","J06.9","J01.90","M19.90"],"date":["2021-10-19","2021-10-19","2021-12-28","2021-02-23","2021-12-28","2021-02-16","2021-02-16","2021-03-30","2021-03-30","2021-06-01","2021-12-28","2021-12-14","2021-12-14","2021-12-14","2021-09-14","2021-12-28","2020-03-03","2020-02-18","2020-03-03","2020-03-03","2020-03-03","2021-08-31","2020-02-18","2021-08-31","2020-08-04","2021-08-31","2021-08-31","2020-08-04","2020-08-04","2021-09-14","2021-09-14","2020-06-02","2020-03-24","2020-05-05","2020-05-05","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-10-19","2021-08-31","2021-03-02","2020-04-21","2021-08-31","2021-04-20","2021-03-16","2021-03-09","2020-03-24","2020-03-24","2021-09-02"],"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":[["","186077660","BRILINTA","60MGTABLET","60","Select","Select",""],["","8627005303","DEXCOM","G6SENSOR","3","Select","Select",""],["","64764017530","DEXILANT","DR60MGCAPSULE","30","Select","Select",""],["","42571025201","CLINDAMYCIN","HCL300MGCAPSULE","30","Select","Select",""],["","56151210401","TRUEPLUS","PENNEEDLE32GX5\/32","100","Select","Select",""],["","68180063802","ATORVASTATIN","80MGTABLET","30","Select","Select",""],["","169255013","TRESIBA","FLEXTOUCH200UNIT\/ML","9","Select","Select",""],["","52817036000","METOPROLOL","TARTRATE25MGTAB","60","Select","Select",""],["","57237007710","ONDANSETRON","ODT4MGTABLET","15","Select","Select",""],["","27241012502","RANOLAZINE","ER500MGTABLET","60","Select","Select",""],["","591236360","TESTOSTERONE","10MGGELPUMP","120","Select","Select",""],["","406012505","HYDROCODONE-ACETAMIN","10-325MG","65","Select","Select",""],["","62559049010","DIPHENOXYLATE-ATROP","2.5-0.025","20","Select","Select",""],["","2879959","HUMALOG","100UNIT\/MLKWIKPEN","15","Select","Select",""],["","68001033308","LISINOPRIL","5MGTABLET","30","Select","Select",""],["","51862094301","DIAZEPAM","10MGTABLET","1","Select","Select",""],["","13668042905","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","37024523","DYMISTA","NASALSPRAY","23","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","50383027201","DICLOFENAC","SODIUM0.01GEL","300","Select","Select",""],["","143924920","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","30","Select","Select",""],["","52817033200","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","60505083305","AZELASTINE","0.001(137MCG)SPRY","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":""}]}]}