{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karen Barfield","gend":1,"add":"342 Old Cedartown Rd","city":"Rockmart","state":"GA","zip":30153,"dob":"1972-08-28","age":"","mstatus":"","insh":1815622004,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"PAMELA HEARN","ppno":"","pcpadd":"2370 Rockmart Hwy,Suite 10","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":["F41.9","F33.1","F44.6","F43.10","K52.9","F44.9","F43.12","E66.3","D64.9","Z79.899","Z12.31","M54.12","M25.511","N18.9","Z11.51","Z01.419","R87.610","R30.0","D50.9","I10","G47.30","G83.21","G83.20","G56.01","G43.909","F41.1","E66.9","M54.2","M25.531","G47.33","Z68.41"],"date":["2021-02-02","2020-09-22","2021-12-28","2021-12-28","2021-03-02","2021-08-10","2021-08-10","2020-06-16","2020-06-16","2021-08-10","2021-08-10","2020-12-22","2020-11-03","2020-11-17","2021-04-27","2021-04-27","2021-04-27","2021-11-09","2021-11-09","2021-07-06","2021-02-02","2020-11-10","2020-12-08","2021-02-02","2021-07-06","2021-07-06","2020-10-27","2020-10-27","2020-12-29","2020-09-08","2020-09-08"],"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":[["","13668001101","CITALOPRAM","HBR40MGTABLET","30","Select","Select",""],["","64380080707","IBUPROFEN","800MGTABLET","21","Select","Select",""],["","406012305","HYDROCODONE-ACETAMIN","5-325MG","10","Select","Select",""],["","68180037703","LOSARTAN","POTASSIUM50MGTAB","30","Select","Select",""],["","2143611","EMGALITY","120MG\/MLPEN","1","Select","Select",""],["","63402030230","LATUDA","20MGTABLET","30","Select","Select",""],["","59762372004","ALPRAZOLAM","0.5MGTABLET","60","Select","Select",""],["","54040013","DESVENLAFAXINE","SUCER50MGTB","30","Select","Select",""],["","555088702","ESTRADIOL","2MGTABLET","30","Select","Select",""],["","31722095301","METHYLPHENIDATE","ER27MGTAB","30","Select","Select",""],["","65862048901","QUETIAPINE","FUMARATE25MGTAB","60","Select","Select",""],["","16729044315","BUPROPION","HCLXL150MGTABLET","30","Select","Select",""],["","10702000350","PROMETHAZINE","25MGTABLET","14","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","93031401","KETOROLAC","10MGTABLET","21","Select","Select",""],["","67877041790","VALSARTAN","160MGTABLET","30","Select","Select",""],["","68462015813","ONDANSETRON","ODT8MGTABLET","10","Select","Select",""],["","93220401","METOCLOPRAMIDE","5MGTABLET","120","Select","Select",""],["","65862007701","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","51293081101","PHENAZOPYRIDINE","200MGTAB","9","Select","Select",""],["","33342008845","RIZATRIPTAN","10MGTABLET","8","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":""}]}]}