{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A J Wigington","gend":0,"add":"5403 Union Church Rd","city":"Flowery Branch","state":"GA","zip":30542,"dob":"1963-03-29","age":"","mstatus":"","insh":1921523002,"cliId":"","pno":7705612742,"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":["I50.21","J18.9","G93.41","J96.01","E87.2","G93.1","B19.9","R57.9","I13.0","I46.2","I42.6","N18.9","E87.6","F17.210","E83.42","F10.20","Z20.828","Z79.82","Z79.1","Z66","Z51.5","E16.2","E78.5","E78.1","R20.0","R61","I25.2","K21.9","Z82.49","Z86.74","Z20.822","S70.362","J96.00","I49.01","J90","M17.11","I46.9","I10","R94.31","D47.3","K59.00","J94.8","R07.89","G89.29","R40.0","M54.2","I12.9","F17.200","D64.9","B19.20","Z72.0","Z09","Z23","Z68.23","M79.10","D64.89","Z12.11","D50.8","R41.0","Z72.89","F10.10","I42.8","I95.9","Z71.89","Z46.82","F05","B18.2","I45.81","J96.90","R91.8","R07.9","R06.02","R50.9","J06.9","R05","L03.115","J44.9","R41.3","G47.00","D50.9","Z86.79","R57.0","E78.2","J98.11","Z95.1","I11.9","Z68.30","K63.5","M79.641","M79.642","L02.214","L02.416","E46","E78.00","R09.2","I73.9","Z68.24","S16.1XX","Z68.27","D53.9","I47.2","R41.82","S30.863","E78.49","Z68.28","R45.1","R00.1","I95.89","Z74.3","J30.1","Z98.890","Z68.26","Z45.2","Z86.010","J98.4","J81.1","M19.90","H61.23","H93.13","J30.9"],"date":["2021-03-30","2020-11-10","2021-07-27","2020-11-10","2020-11-10","2021-01-12","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2021-06-08","2021-01-12","2021-06-08","2020-11-10","2021-07-27","2020-11-10","2020-11-10","2020-11-10","2021-01-05","2020-11-10","2020-11-10","2021-07-06","2021-07-06","2021-06-08","2021-06-08","2021-06-08","2021-07-06","2021-06-08","2021-06-08","2021-07-06","2020-07-14","2020-10-13","2021-02-11","2021-07-27","2020-11-03","2021-07-27","2021-09-22","2021-03-30","2021-01-05","2021-02-23","2020-10-20","2021-07-06","2021-06-01","2021-06-01","2020-09-08","2020-07-21","2021-06-08","2021-07-27","2021-02-23","2021-07-27","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2020-10-13","2020-10-13","2020-10-20","2020-10-13","2021-07-27","2021-07-27","2020-10-20","2021-01-05","2021-01-05","2021-01-05","2020-10-13","2020-10-20","2021-06-01","2021-02-11","2020-03-31","2020-05-19","2020-05-19","2020-08-25","2021-04-20","2021-09-22","2021-04-20","2021-04-20","2021-04-20","2020-12-22","2021-02-23","2021-06-01","2020-10-20","2021-06-08","2021-06-08","2021-03-02","2020-07-21","2020-05-12","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-10-06","2021-01-12","2020-12-08","2020-07-07","2021-02-23","2020-10-20","2021-01-12","2020-11-03","2020-07-14","2021-02-11","2021-02-11","2021-03-23","2020-10-20","2021-07-27","2020-11-03","2020-05-19","2020-10-13","2020-12-22","2020-10-13","2021-03-02","2020-10-20","2020-10-13","2021-09-22","2021-09-22","2021-09-22","2021-06-01"],"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":[["","115552210","FENOFIBRATE","160MGTABLET","30","Select","Select",""],["","16714068403","SIMVASTATIN","40MGTABLET","30","Select","Select",""],["","68180015301","DESLORATADINE","5MGTABLET","30","Select","Select",""],["","52817033200","CYCLOBENZAPRINE","10MGTABLET","20","Select","Select",""],["","50111056002","TRAZODONE","50MGTABLET","30","Select","Select",""],["","27241009990","DULOXETINE","HCLDR60MGCAP","30","Select","Select",""],["","16714012303","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","50742061505","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","173086910","ANORO","ELLIPTA62.5-25MCGINH","60","Select","Select",""],["","378415105","TRAMADOL","HCL50MGTABLET","30","Select","Select",""],["","69238110005","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","904675180","ASPIRIN","EC81MGTABLET","30","Select","Select",""],["","43598044774","NICOTINE","14MG\/24HRPATCH","28","Select","Select",""],["","29300039710","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","60505311108","OLANZAPINE","5MGTABLET","30","Select","Select",""],["","13107000105","MIRTAZAPINE","7.5MGTABLET","30","Select","Select",""],["","67877025130","TRIAMCINOLONE","0.001CREAM","30","Select","Select",""],["","254100752","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","16714073201","CELECOXIB","100MGCAPSULE","30","Select","Select",""],["","16714066201","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","65862050301","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","72205000499","ROSUVASTATIN","CALCIUM20MGTAB","30","Select","Select",""],["","65162019010","NAPROXEN","500MGTABLET","30","Select","Select",""],["","62332015030","OLMESARTAN-HCTZ","40-12.5MGTAB","30","Select","Select",""],["","591544310","PREDNISONE","20MGTABLET","10","Select","Select",""],["","16714087702","ATORVASTATIN","80MGTABLET","30","Select","Select",""],["","43547028810","BUPROPION","HCLSR100MGTABLET","60","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":""}]}]}