{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Giva Brady","gend":1,"add":"113 Trentwood Pl NW","city":"Rome","state":"GA","zip":30165,"dob":"1964-05-24","age":"","mstatus":"","insh":1904663001,"cliId":"","pno":2104046238,"cno":"","email":"givabrady@icloud.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":["D70.1","Z51.89","C25.0","R19.7","E86.0","E83.42","T45.1X5","Z51.11","R11.0","F33.9","E78.5","K21.9","M19.90","F41.9","M54.9","E83.39","I10","G89.29","M41.9","Z20.822","Z92.21","Z87.442","Z90.721","Z79.899","K86.9","D64.9","E87.6","F32.9","Z87.891","K59.00","Z80.0","G57.90","J30.9","M25.512","N13.2","I25.10","C25.9","R00.0","M06.9","F41.8","Z90.49","Z91.81","K82.8","Z23","Z20.3","Z29.14","F17.210","M79.642","M19.012","R42","Z85.07","J18.9","D61.818","E44.0","F39","R65.10","Z68.25","T40.2X1","Z04.6","F19.129","F33.1","R45.851","F12.129","F11.129","K86.89","M48.02","G93.41","K92.2","E03.9","Z98.890","K30","T18.2XX","M25.78","M47.22","M47.12","S00.83X","M54.12","R94.31","T40.601","G89.4","R10.84","K92.0","D50.9","R55","M50.13","E78.00","F17.200","Z98.82","K83.8","Z20.828","S46.012","E66.9","Z68.30","R10.9","Z79.891","Z87.440","Z98.1","E87.1","E83.52","R03.0","M79.602","R60.0","M75.52","M75.42","Z95.5","K86.1","R41.82","R91.8","R07.9","R63.0","M54.2","S19.9XX","S00.33X","S09.90X","F41.1","G47.01","E53.8","E55.9","E78.2","F33.0","K76.9","K74.00","K76.0","K85.90","G89.18","R82.90","M94.212","M65.812","K81.1","N20.1","R10.31","N39.0","E83.51","R91.1","N13.5","D63.0","N32.89","R04.0","R06.02","C25.1","R10.13","R41.0","G61.89","M47.812","M79.18","M62.81","I47.2","Z12.31","T50.901","K59.03","T88.7XX","A41.9","M50.30","I48.0","Z51.5","J06.9","S39.82X","S49.90X","R29.6","W18.39X","Y92.018","S39.012","M79.632","R00.8","Z45.2","M51.37","M50.323","M50.33","M54.6","R29.898","Z01.818","N20.0","D61.810","F51.01","M54.5","I21.4","T50.902","R09.02","B34.9","T14.8XX","M25.619","K63.89","S02.2XX","M75.22","R07.89","T50.991","R46.4","M79.89","R30.0","S61.432","G89.11","S49.92X","J01.01","H93.8X3","M43.12","Z76.89","H10.9"],"date":["2021-11-18","2021-11-18","2021-12-08","2021-10-06","2021-07-27","2021-08-31","2021-10-20","2021-10-20","2021-10-20","2021-03-30","2021-08-31","2021-08-31","2021-03-30","2021-08-31","2021-03-30","2021-03-30","2021-10-05","2021-08-03","2021-03-30","2021-09-14","2021-07-06","2021-08-17","2021-03-30","2021-09-21","2020-10-20","2021-10-05","2021-07-06","2021-07-06","2021-08-31","2021-03-02","2020-10-06","2020-09-22","2020-10-06","2021-12-28","2021-09-14","2021-10-05","2021-11-18","2021-10-05","2021-10-05","2021-10-05","2021-05-25","2021-06-29","2020-09-22","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-12-28","2021-04-20","2021-08-31","2021-11-09","2021-08-31","2021-10-06","2021-08-31","2021-10-06","2021-08-31","2021-05-11","2021-05-11","2021-05-11","2021-07-20","2021-05-11","2021-05-11","2021-05-11","2021-02-09","2020-11-24","2021-03-02","2021-03-02","2021-03-02","2021-10-12","2021-03-02","2021-02-09","2020-10-06","2020-12-01","2020-10-06","2021-08-17","2020-11-24","2021-04-27","2021-06-08","2021-07-06","2021-03-23","2021-02-11","2021-02-11","2021-04-20","2020-12-01","2020-11-10","2020-10-27","2020-10-27","2020-10-13","2021-01-26","2020-09-29","2020-09-29","2020-09-29","2021-03-16","2020-09-29","2020-09-29","2021-07-06","2020-10-06","2020-10-20","2020-10-06","2020-08-11","2020-08-11","2020-06-23","2020-06-23","2021-08-31","2020-11-03","2021-09-28","2021-10-06","2021-10-12","2021-07-20","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-06-29","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-22","2021-10-12","2021-10-12","2020-11-10","2021-05-25","2020-12-29","2020-09-29","2020-09-29","2021-02-02","2021-12-08","2021-02-09","2020-12-08","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-10-12","2021-10-12","2021-07-20","2021-06-15","2021-02-11","2020-11-24","2020-11-24","2020-11-24","2021-02-09","2021-02-09","2020-01-07","2021-02-09","2021-02-09","2021-02-09","2021-11-09","2020-08-25","2021-02-11","2021-02-23","2021-09-22","2021-03-16","2021-03-16","2021-04-20","2021-03-16","2021-03-16","2020-02-11","2021-04-20","2021-02-23","2021-03-16","2020-02-04","2020-10-20","2020-10-20","2021-05-04","2020-06-23","2021-02-02","2021-12-08","2021-10-06","2020-07-21","2021-04-20","2021-04-27","2021-04-06","2021-04-06","2021-09-22","2021-04-13","2020-09-08","2020-10-20","2021-09-07","2021-11-18","2020-10-06","2021-01-19","2021-09-07","2020-03-03","2021-07-27","2020-09-15","2020-09-15","2021-04-27","2020-06-16","2020-06-16","2020-07-14","2022-01-06","2020-02-04"],"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":[["","68001045600","ESCITALOPRAM","20MGTABLET","30","Select","Select",""],["","68001031600","LOVASTATIN","40MGTABLET","60","Select","Select",""],["","55111018010","TIZANIDINE","HCL4MGTABLET","90","Select","Select",""],["","62559049001","DIPHENOXYLATE-ATROP","2.5-0.025","60","Select","Select",""],["","68382018205","BUSPIRONE","HCL15MGTABLET","60","Select","Select",""],["","115521116","COLESTIPOL","HCL1GMTABLET","60","Select","Select",""],["","33342002332","LEVOFLOXACIN","750MGTABLET","5","Select","Select",""],["","65862056099","PANTOPRAZOLE","SODDR40MGTAB","60","Select","Select",""],["","59762372104","ALPRAZOLAM","1MGTABLET","60","Select","Select",""],["","67877022310","GABAPENTIN","300MGCAPSULE","60","Select","Select",""],["","406048410","ACETAMINOPHEN-COD","#3TABLET","12","Select","Select",""],["","59746011306","PROCHLORPERAZINE","5MGTABLET","60","Select","Select",""],["","406012305","HYDROCODONE-ACETAMIN","5-325MG","10","Select","Select",""],["","69547035302","NARCAN","4MGNASALSPRAY","2","Select","Select",""],["","67877019805","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","57237007630","ONDANSETRON","HCL8MGTABLET","24","Select","Select",""],["","68462039710","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","16571020210","DICLOFENAC","SODEC50MGTAB","28","Select","Select",""],["","68382031910","TRAMADOL","HCL50MGTABLET","30","Select","Select",""],["","61314062810","POLYMYXIN","B-TMPEYEDROPS","10","Select","Select",""],["","591544310","PREDNISONE","20MGTABLET","14","Select","Select",""],["","69097095805","PREGABALIN","150MGCAPSULE","60","Select","Select",""],["","42858010301","OXYCODON-ACETAMINOPHEN","7.5-325","18","Select","Select",""],["","68001039803","FAMOTIDINE","40MGTABLET","30","Select","Select",""],["","57664050658","METOPROLOL","TARTRATE25MGTAB","60","Select","Select",""],["","70010075401","METHOCARBAMOL","500MGTABLET","60","Select","Select",""],["","51991074690","DULOXETINE","HCLDR20MGCAP","28","Select","Select",""],["","52817033050","CYCLOBENZAPRINE","5MGTABLET","60","Select","Select",""],["","68001023503","POTASSIUM","CLER20MEQTABLET","30","Select","Select",""],["","68180071160","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE","25MGTAB","5","Select","Select",""],["","68180039601","CELECOXIB","100MGCAPSULE","28","Select","Select",""],["","59762040105","SUCRALFATE","1GMTABLET","120","Select","Select",""],["","406055201","OXYCODONE","HCL5MGTABLET","7","Select","Select",""],["","68382004110","PROMETHAZINE","25MGTABLET","32","Select","Select",""],["","16571066450","METRONIDAZOLE","500MGTABLET","14","Select","Select",""],["","68001000501","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","66685100100","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","16729013716","CLONAZEPAM","1MGTABLET","60","Select","Select",""],["","69097015907","MELOXICAM","15MGTABLET","12","Select","Select",""],["","59762219803","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","60505083305","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","67877021660","CEFUROXIME","AXETIL500MGTAB","12","Select","Select",""],["","48102004701","DEXAMETHASONE","4MGTABLET","5","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":""}]}]}