{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vicki Little","gend":1,"add":"234 Alfred Ave SE","city":"Rome","state":"GA","zip":30161,"dob":"1960-04-27","age":"","mstatus":"","insh":196071001,"cliId":"","pno":7069360155,"cno":"","email":"vlitt03@aol.com","ename":"","eno":"","pphy":"STEPHANIE STUTZ","ppno":"","pcpadd":"304 Shorter Avenue NW,Suite 20","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":["M25.561","M25.661","S83.241","H69.83","H92.01","H60.543","J30.89","E11.9","E78.5","I10","R79.89","I25.119","Z68.33","S30.1XX","R07.9","R42","H81.11","E03.9","E11.69","E78.2","K31.83","Z12.31","Z51.81","G89.29","Z00.00","Z13.31","Z60.2","Z97.3","Z95.5","Z99.89","Z87.891","M54.5","K21.9","M25.562","E11.22","H66.91","I12.9","N18.9","R00.1","Z87.442","Z90.710","Z79.02","Z79.899","E55.9","I25.10","Z79.82","I25.110","Z20.822","B34.9","G47.33","Z79.84","I11.9","I51.89","R80.9","K76.0","M54.6","M17.10","I20.0","J01.90","M25.551","S83.8X1","S73.191","Z23","S83.8X2","M23.321","R07.2","M54.2","M17.11","M22.41","M62.81","M79.604","S75.091","R26.9","G89.11"],"date":["2021-08-17","2021-08-17","2021-08-17","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-10-05","2021-04-27","2021-12-14","2021-10-05","2020-01-22","2021-02-02","2020-04-28","2020-05-26","2020-08-25","2020-04-21","2021-09-14","2020-05-19","2020-05-19","2020-03-03","2020-12-15","2020-09-01","2020-08-25","2020-07-21","2021-04-27","2020-07-21","2020-07-21","2021-02-02","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2021-12-28","2020-05-05","2020-04-28","2020-04-21","2020-04-21","2020-04-28","2020-04-21","2020-04-21","2020-04-28","2020-04-21","2020-08-18","2021-02-02","2020-05-19","2020-05-05","2021-11-09","2021-11-09","2020-03-31","2020-05-19","2020-05-19","2020-05-19","2021-10-05","2020-05-19","2020-05-19","2021-04-20","2020-04-28","2020-02-04","2021-04-27","2021-03-16","2021-03-16","2021-10-05","2021-10-05","2021-05-25","2020-04-28","2021-11-09","2021-04-27","2021-04-27","2021-04-27","2020-04-28","2020-04-28","2020-05-26","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":[["","781261305","AMOXICILLIN","500MGCAPSULE","20","Select","Select",""],["","13668010401","ISOSORBIDE","MONONITER30MGTB","30","Select","Select",""],["","65862029630","ROSUVASTATIN","CALCIUM40MGTAB","30","Select","Select",""],["","49281042050","FLUZONE","QUAD2020-2021SYRINGE","0.5","Select","Select",""],["","55111019605","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","67877049090","EZETIMIBE","10MGTABLET","30","Select","Select",""],["","52817036000","METOPROLOL","TARTRATE25MGTAB","30","Select","Select",""],["","536100836","ASPIRIN","81MGCHEWABLETABLET","30","Select","Select",""],["","6057561","JANUMET","50-500MGTABLET","60","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4MGTABLETSL","25","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","15","Select","Select",""],["","45802005535","TRIAMCINOLONE","0.001OINTMENT","30","Select","Select",""],["","60432060416","PROMETHAZINE-DM","SYRUP","300","Select","Select",""],["","68180051201","LISINOPRIL","2.5MGTABLET","30","Select","Select",""],["","29300035505","TRAMADOL","HCL50MGTABLET","10","Select","Select",""],["","378580793","VALSARTAN","40MGTABLET","30","Select","Select",""],["","65162019050","NAPROXEN","500MGTABLET","60","Select","Select",""],["","781185220","AMOX-CLAV","875-125MGTABLET","14","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":""}]}]}