{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sylvia Small","gend":1,"add":"1411 Calhoun Ave NE","city":"Rome","state":"GA","zip":30161,"dob":"1962-11-28","age":"","mstatus":"","insh":1694719001,"cliId":"","pno":7062332713,"cno":"","email":"smallsylvia7@gmail.com","ename":"","eno":"","pphy":"Joshua Behlmann","ppno":"","pcpadd":"10 Main Street Market Place,N","pcpcity":"Cartersville","pcpstate":"GA","pcpzip":"","pcpcounty":"Cartersville","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":["M10.9","M06.9","E55.9","B35.1","E11.40","R79.89","L97.902","M79.604","R50.9","R10.9","R51","R42","I10","K21.9","E66.01","F17.210","L24.0","L29.9","R53.83","L85.3","Z68.43","G89.4","J45.909","E78.5","Z12.31","R10.2","S39.91X","S39.93X","R07.9","S29.9XX","M54.6","M54.5","S39.92X","M54.2","S19.9XX","Z79.899","Z68.45","J01.90","R06.00","R05","J01.80","L20.89","L89.612","M79.672","R60.0","J30.89","Z20.822","G89.29","L20.9","M75.31","M60.272","S79.921","S19.89X","S55.001","V49.88X","Y92.410","F34.1","J30.9","J30.81","J30.1","J45.20","Z91.018","S09.90X","J30.2","Z18.89","K58.9","S06.9X9","G89.11","V49.40X","N63.14","D24.2","D24.1","Z12.39","M25.511","M77.9","M19.011","Z20.828","R94.31","K21.0","M79.605"],"date":["2020-08-11","2020-08-11","2020-08-11","2020-09-01","2020-08-11","2020-08-11","2020-08-11","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-12-28","2021-09-22","2021-01-26","2021-01-26","2020-05-05","2020-06-23","2021-12-28","2020-05-05","2021-07-20","2021-12-28","2020-12-22","2021-04-13","2020-12-22","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-12-22","2020-11-03","2020-11-03","2020-11-03","2021-12-28","2021-12-28","2020-04-09","2020-04-09","2020-04-09","2020-09-22","2020-09-22","2020-08-11","2021-08-05","2021-07-20","2021-07-20","2021-10-26","2021-09-23","2020-07-21","2020-04-21","2021-08-04","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-12-22","2021-09-22","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2020-11-03","2021-06-22","2021-08-05","2020-07-14","2020-12-22","2020-12-22","2020-12-22","2021-12-21","2021-12-21","2021-12-21","2021-12-14","2020-04-21","2020-04-21","2020-06-02","2021-10-12","2020-11-17","2020-04-21","2020-08-04"],"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":[["","43547040011","CYCLOBENZAPRINE","10MGTABLET","90","Select","Select",""],["","143924920","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","55111072510","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","27808003603","HYDROCODONE-ACETAMIN","7.5-325","120","Select","Select",""],["","43547041209","QUINAPRIL","20MGTABLET","30","Select","Select",""],["","68382009810","PAROXETINE","HCL20MGTABLET","30","Select","Select",""],["","45802006435","TRIAMCINOLONE","0.001CREAM","15","Select","Select",""],["","68047025301","OSCIMIN","SL0.125MGTABLET","79","Select","Select",""],["","49483060450","IBUPROFEN","800MGTABLET","15","Select","Select",""],["","93506101","HYDROXYZINE","HCL25MGTABLET","30","Select","Select",""],["","68462039710","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","60432060416","PROMETHAZINE-DM","SYRUP","120","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","67877021905","CEPHALEXIN","500MGCAPSULE","20","Select","Select",""],["","68180096301","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","80777027398","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","173068220","VENTOLIN","HFA90MCGINHALER","18","Select","Select",""],["","42192033901","HYOSCYAMINE","0.125MGTABSL","79","Select","Select",""],["","62135098505","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","57664037718","TRAMADOL","HCL50MGTABLET","15","Select","Select",""],["","69238117009","DOXEPIN","25MGCAPSULE","50","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","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":""}]}]}