{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bryan Thaxton","gend":0,"add":"291 Stonington Dr","city":"Mount Airy","state":"GA","zip":30563,"dob":"1976-11-18","age":"","mstatus":"","insh":1983743001,"cliId":"","pno":7069680859,"cno":"","email":"bryan.thaxton@gmail.com","ename":"","eno":"","pphy":"JOSHUA GARRETT","ppno":"","pcpadd":"541 441 Historic Hwy N","pcpcity":"Demorest","pcpstate":"GA","pcpzip":"","pcpcounty":"Demorest","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":["R00.1","R42","R61","R53.83","I10","E78.5","F12.90","Z87.891","F41.9","M25.462","R00.2","Z68.32","F17.210","Z95.0","F12.10","K21.9","Z20.828","G47.33","F90.9","I44.2","E78.1","M45.9","L03.115","Z68.33","D64.9","E86.0","R55","M45.7","Z79.899","Z11.1","Z68.34","F17.200","M25.50","R94.31","Z00.01","Z11.59","R53.81","F90.2","I44.1","G89.29","R53.1","F32.9","M54.5","R07.89","F98.9","K21.01","Z13.31","R07.9","R06.02"],"date":["2021-08-03","2020-11-24","2020-11-24","2020-11-17","2021-10-05","2020-11-17","2021-03-23","2020-11-17","2021-10-05","2020-02-18","2020-02-18","2021-06-29","2021-03-23","2021-08-03","2021-01-05","2021-02-23","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-06-29","2021-06-29","2021-03-23","2021-10-05","2021-06-29","2020-03-10","2020-11-24","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-02-18","2020-02-04","2020-11-17","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2020-11-24","2021-10-05","2021-02-23","2020-06-02","2020-12-29","2020-12-29","2021-06-29","2020-11-17","2020-11-17"],"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":[["","67877024601","QUETIAPINE","FUMARATE200MGTAB","30","Select","Select",""],["","16729013716","CLONAZEPAM","1MGTABLET","45","Select","Select",""],["","69543013611","TRAMADOL","HCL50MGTABLET","180","Select","Select",""],["","43547028110","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","65862020299","LOSARTAN","POTASSIUM50MGTAB","30","Select","Select",""],["","115166101","PROPRANOLOL","40MGTABLET","60","Select","Select",""],["","65862052301","GABAPENTIN","600MGTABLET","90","Select","Select",""],["","74055402","HUMIRA(CF)","PEN40MG\/0.4ML","2","Select","Select",""],["","16714099101","ROSUVASTATIN","CALCIUM40MGTAB","30","Select","Select",""],["","115552210","FENOFIBRATE","160MGTABLET","30","Select","Select",""],["","76282057190","PREGABALIN","100MGCAPSULE","90","Select","Select",""],["","555097402","DEXTROAMP-AMPHETAMIN","30MGTAB","60","Select","Select",""],["","16571020106","DICLOFENAC","SODEC75MGTAB","60","Select","Select",""],["","68180012201","CEPHALEXIN","500MGCAPSULE","21","Select","Select",""],["","16714048401","DIVALPROEX","SODER250MGTAB","60","Select","Select",""],["","65162046510","IBUPROFEN","600MGTABLET","90","Select","Select",""],["","16714088502","ACYCLOVIR","0.05OINTMENT","30","Select","Select",""],["","29300024618","BUSPIRONE","HCL15MGTABLET","90","Select","Select",""],["","68462030201","INDOMETHACIN","50MGCAPSULE","90","Select","Select",""],["","29300022701","METRONIDAZOLE","500MGTABLET","21","Select","Select",""],["","65862052890","VENLAFAXINE","HCLER75MGCAP","60","Select","Select",""],["","68462029855","CLOTRIMAZOLE-BETAMETHASONE","CRM","45","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":""}]}]}