{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susanne Mull","gend":1,"add":"572 Kanuga St","city":"Hiawassee","state":"GA","zip":30546,"dob":"1961-07-24","age":"","mstatus":"","insh":2024709001,"cliId":"","pno":7068965667,"cno":"","email":"susannemull@mail.com","ename":"","eno":"","pphy":"Brent Flickinger","ppno":"","pcpadd":"961 Smoky Mountain Springs Lane NE Ste A","pcpcity":"Gainesville","pcpstate":"GA","pcpzip":"","pcpcounty":"Gainesville","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":["J12.82","I26.99","E83.42","D64.9","I10","E03.9","F41.9","M06.9","Z79.899","Z88.5","Z88.8","Z91.048","Z90.49","Z80.9","R06.02","B34.9","M79.642","M19.042","M79.641","M18.11","M19.041","M17.12","M25.562","M17.11","M25.561","R06.00","Z20.828","R91.8","R05","U07.1","M25.50","R53.83","R76.8","R70.0","Z79.891","M05.79","Z68.41","R79.9","E55.9","Z79.890","E11.9","Z01.419","N95.0","M54.5","R63.5","F32.9","M54.16","A41.9","M06.00","J02.9","R52","Z86.19","E66.3","E66.9","R73.01","M19.90","J84.9","R06.03"],"date":["2021-07-06","2021-05-25","2021-07-06","2021-07-06","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-11-02","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-01-26","2021-01-26","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-10-19","2021-04-27","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-07-06","2021-04-13","2021-04-13","2021-04-13","2021-07-20","2021-11-02","2021-10-19","2021-10-19","2020-11-24","2021-05-11","2020-07-28","2020-07-28","2021-12-16","2021-12-08","2020-11-24","2021-05-11","2020-11-24","2020-09-29","2021-01-19","2021-07-20","2021-01-19","2021-01-19","2021-01-19","2020-06-16","2021-01-12","2021-01-12","2020-09-01","2021-01-19","2021-01-26"],"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":[["","62332012190","PREGABALIN","75MGCAPSULE","90","Select","Select",""],["","68382039801","POTASSIUM","CLER20MEQTABLET","30","Select","Select",""],["","65862037505","ESCITALOPRAM","20MGTABLET","30","Select","Select",""],["","70461032003","FLUCELVAX","QUAD2020-2021SYR","0.5","Select","Select",""],["","29300013605","CLONIDINE","HCL0.2MGTABLET","120","Select","Select",""],["","68180052002","LISINOPRIL-HCTZ","20-25MGTAB","60","Select","Select",""],["","69315014001","GLYCOPYRROLATE","2MGTABLET","100","Select","Select",""],["","69097012212","TOPIRAMATE","25MGTABLET","60","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","120","Select","Select",""],["","59746017310","PREDNISONE","10MGTABLET","10","Select","Select",""],["","23155010210","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","59762500002","SULFASALAZINE","500MGTABLET","60","Select","Select",""],["","64380073706","VITAMIN","D21.25MG(50,000UNIT)","12","Select","Select",""],["","68180097001","LEVOTHYROXINE","112MCGTABLET","30","Select","Select",""],["","406012510","HYDROCODONE-ACETAMIN","10-325MG","84","Select","Select",""],["","16714069211","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","69315012710","FOLIC","ACID1MGTABLET","30","Select","Select",""],["","68382009405","CARVEDILOL","12.5MGTABLET","60","Select","Select",""],["","23155060503","MODAFINIL","200MGTABLET","30","Select","Select",""],["","3089421","ELIQUIS","5MGTABLET","60","Select","Select",""],["","58160082311","SHINGRIX","VIALKIT","1","Select","Select",""],["","74055402","HUMIRA(CF)","PEN40MG\/0.4ML","2","Select","Select",""],["","70748013006","LEFLUNOMIDE","20MGTABLET","30","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","21","Select","Select",""],["","80777027315","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","57894007002","SIMPONI","50MG\/0.5MLPENINJEC","0.5","Select","Select",""],["","15370016010","GLYCATE","1.5MGTABLET","30","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","66689000816","NYSTATIN","100000UNIT\/MLSUSP","140","Select","Select",""],["","254100752","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","16714039102","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","6494300","PNEUMOVAX","23VIAL","0.5","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":["",""]}},{"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":""}]}]}