{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tracy Brooks","gend":1,"add":"743 Kerce Rd","city":"Kingston","state":"GA","zip":30145,"dob":"1970-06-24","age":"","mstatus":"","insh":1867674001,"cliId":"","pno":7062526194,"cno":"","email":"tracygibson2301@gmail.com","ename":"","eno":"","pphy":"James Douglas","ppno":"","pcpadd":"15 Riverbend Drive SW Ste 200","pcpcity":"Rome","pcpstate":"GA","pcpzip":"","pcpcounty":"Rome","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":["G43.909","R60.0","D72.829","R07.9","R11.0","H53.149","I25.10","I25.2","Z98.61","G56.02","Z90.5","G89.4","R10.84","R11.2","G47.00","R53.83","M54.2","Z00.00","E53.8","R20.8","G43.009","M54.12","M47.812","Z79.891","M54.16","M51.36","M47.816","F11.20","Z28.20","A41.9","N39.0","B96.20","N13.30","R55","E11.9","I10","R51.9","N18.9","Q60.0","Z87.442","G43.719","E66.3","Z13.39","Z78.9","G89.29","R10.9","G43.011","B35.4","Z95.5","F41.9","M62.838","Z02.89","M62.830","R31.9","R03.0","I34.0","R82.90","M54.5","G43.001","I21.4","T46.3X5","R25.1","T40.2X5","Z20.822","M50.90","Z90.49","Z90.89","E78.5","M54.81","F41.1","F33.0","I72.9","G44.209","M54.9","R20.2","G97.1","G56.22","G43.919","M53.82","Z01.419","R00.0","N76.0","M50.30","R51","I24.9","R54","N30.00","M79.641","M79.642","M79.671","M79.672","R07.89","L56.8","R30.0","G43.109","N95.1","M77.12","J40","R06.00","M65.831","M65.832","I44.30","I50.9","R06.02","J11.1","A09","R50.9","Z20.828","R53.1","E13.9","R45.4","R68.82","I25.110","N20.0","G43.119","R10.31","A04.8","R11.11","M06.4","R10.2","R10.12","R79.89","F51.01","G43.101","M54.41","M79.651","Z79.899","I25.119","S09.90X","G43.019"],"date":["2021-12-21","2020-12-08","2022-01-06","2021-10-19","2021-11-23","2021-11-23","2021-12-14","2021-12-14","2021-12-14","2020-10-13","2021-10-05","2021-08-31","2021-03-30","2021-12-21","2021-12-07","2021-09-07","2021-12-28","2021-03-30","2021-04-27","2020-08-11","2021-07-20","2021-12-28","2021-11-09","2021-01-26","2021-12-28","2021-03-02","2021-12-28","2021-12-28","2021-11-09","2021-08-31","2021-10-05","2021-08-31","2021-10-05","2021-12-28","2021-04-06","2021-05-25","2022-01-06","2021-04-20","2021-04-20","2021-08-10","2022-01-04","2021-09-21","2021-09-21","2021-09-21","2021-05-25","2021-03-02","2021-10-26","2020-10-27","2021-08-10","2021-05-25","2021-03-30","2021-01-26","2021-06-22","2021-08-10","2020-12-08","2020-02-04","2020-04-28","2021-02-16","2021-12-07","2021-05-18","2021-05-25","2021-05-25","2021-05-25","2022-01-06","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-10-26","2021-12-28","2021-12-28","2021-12-07","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2020-06-02","2021-04-20","2021-10-26","2021-09-14","2021-05-18","2021-08-10","2020-06-23","2020-10-20","2021-06-22","2021-05-18","2021-09-14","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-10-19","2020-11-17","2020-11-24","2021-10-12","2021-12-28","2021-09-01","2022-01-06","2021-05-11","2021-11-23","2021-11-23","2021-06-01","2020-01-22","2021-05-18","2021-02-23","2021-02-23","2021-02-23","2020-11-03","2020-09-01","2021-05-25","2021-12-28","2021-12-28","2021-06-01","2021-09-07","2020-09-08","2021-08-10","2020-09-22","2020-09-22","2021-01-19","2021-02-02","2021-12-07","2021-12-07","2020-03-03","2020-10-06","2020-03-31","2020-03-31","2021-08-31","2021-06-22","2021-12-28","2020-04-09"],"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":[["","641092925","PROMETHAZINE","50MG\/MLVIAL","10","Select","Select",""],["","62559014901","ESTROGEN-METHYLTESTOS","F.S.TAB","30","Select","Select",""],["","65862052305","GABAPENTIN","600MGTABLET","112","Select","Select",""],["","50383066730","LIDOCAINE-PRILOCAINE","CREAM","150","Select","Select",""],["","68180063709","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","62332025130","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","16729013800","CLONAZEPAM","2MGTABLET","30","Select","Select",""],["","70069000510","CYANOCOBALAMIN","1000MCG\/ML","5","Select","Select",""],["","406052301","OXYCODONE-ACETAMINOPHEN","10-325","60","Select","Select",""],["","2143611","EMGALITY","120MG\/MLPEN","1","Select","Select",""],["","10702000801","OXYCODONE","HCL15MGTABLET","112","Select","Select",""],["","69547035302","NARCAN","4MGNASALSPRAY","2","Select","Select",""],["","69097084615","CYCLOBENZAPRINE","10MGTABLET","56","Select","Select",""],["","527293243","PREDNISONE","5MGTABLET","40","Select","Select",""],["","43598043601","NITROGLYCERIN","0.4MGTABLETSL","25","Select","Select",""],["","45802058084","SCOPOLAMINE","1MG\/3DAYPATCH","1","Select","Select",""],["","52817036000","METOPROLOL","TARTRATE25MGTAB","30","Select","Select",""],["","409162601","BUTORPHANOL","2MG\/MLVIAL","10","Select","Select",""],["","72618300002","NURTEC","ODT75MGTABLET","16","Select","Select",""],["","65862052890","VENLAFAXINE","HCLER75MGCAP","30","Select","Select",""],["","527169501","BUTALB-ACETAMIN-CAFF","50-325-40","30","Select","Select",""],["","50111045001","TRAZODONE","150MGTABLET","30","Select","Select",""],["","51672128901","NYSTATIN","100000UNIT\/GMCREAM","45","Select","Select",""],["","69315011710","FUROSEMIDE","40MGTABLET","30","Select","Select",""],["","23392102","BOTOX","200UNITVIAL","1","Select","Select",""],["","51991070701","ALPRAZOLAM","2MGTABLET","30","Select","Select",""],["","555087202","MEDROXYPROGESTERONE","2.5MGTAB","30","Select","Select",""],["","62332012190","PREGABALIN","75MGCAPSULE","14","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","40","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","67877021905","CEPHALEXIN","500MGCAPSULE","20","Select","Select",""],["","143992801","CIPROFLOXACIN","HCL500MGTAB","10","Select","Select",""],["","68462011944","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","69097052444","DICLOFENAC","SODIUM0.01GEL","100","Select","Select",""],["","42806001101","SULINDAC","200MGTABLET","60","Select","Select",""],["","70710122901","AMITRIPTYLINE","HCL100MGTAB","30","Select","Select",""],["","59762135001","RIFABUTIN","150MGCAPSULE","20","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","120","Select","Select",""],["","33342002108","LEVOFLOXACIN","250MGTABLET","10","Select","Select",""],["","69315090601","LORAZEPAM","2MGTABLET","30","Select","Select",""],["","172392770","DIAZEPAM","10MGTABLET","60","Select","Select",""],["","13913000519","GRALISE","ER600MGTABLET","90","Select","Select",""],["","23649810","UBRELVY","50MGTABLET","10","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}