{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Phyllis Swords","gend":1,"add":"56 Echols St","city":"Lyerly","state":"GA","zip":30730,"dob":"1958-02-10","age":"","mstatus":"","insh":210675001,"cliId":"","pno":7068952128,"cno":"","email":"rls256@gmail.com","ename":"","eno":"","pphy":"Wayne Richey","ppno":"","pcpadd":"11 Charley Harper Drive,Suite 10","pcpcity":"Cartersville","pcpstate":"GA","pcpzip":"","pcpcounty":"Cartersville","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":["R10.11","R07.81","E11.9","I10","R79.89","Z79.899","I48.91","I34.0","I50.1","N17.9","N64.59","I21.4","E87.70","K74.60","I51.7","Z46.59","A41.01","K72.90","I33.0","R01.0","K75.81","R93.2","K80.20","J06.9","R91.8","R16.0","K72.00","E80.6","R40.0","R53.83","M19.90","M25.569","G89.29","K21.9","Z13.31","K76.0","R93.5","Z90.49","N63.10","R17","M79.601","R60.0","H00.12","Z13.220","G24.3","B95.61","K21.0","J81.1","G47.33","N64.89","R92.1","Z86.39","R94.31","M79.89","R18.8","I31.3","I31.8","I30.8","I34.8","C22.0","H01.001","Z45.2","R06.83","R74.8"],"date":["2020-11-10","2020-11-17","2021-09-07","2021-09-07","2021-12-21","2021-09-07","2021-11-23","2021-11-23","2021-11-23","2021-12-28","2020-11-24","2021-11-09","2021-11-09","2021-12-08","2021-12-28","2021-12-28","2021-12-16","2021-12-16","2021-12-28","2021-12-28","2021-11-23","2021-03-23","2021-12-16","2021-12-16","2021-12-16","2021-11-23","2021-12-08","2021-11-09","2021-09-07","2021-09-07","2021-09-07","2020-07-21","2020-07-21","2020-11-17","2021-09-07","2020-11-10","2020-11-10","2020-11-10","2020-11-17","2021-11-23","2021-11-30","2021-11-30","2021-01-19","2021-09-07","2021-11-02","2021-12-08","2020-03-31","2021-12-28","2020-10-20","2020-12-29","2020-12-29","2021-09-07","2021-12-28","2021-12-21","2021-12-21","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2021-12-21","2021-03-16","2021-12-21","2020-08-18","2021-11-18"],"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":[["","597015290","JARDIANCE","10MGTABLET","30","Select","Select",""],["","168005615","BETAMETHASONE","DP0.0005OINT","15","Select","Select",""],["","67877021905","CEPHALEXIN","500MGCAPSULE","40","Select","Select",""],["","65162083366","DICLOFENAC","SODIUM0.01GEL","100","Select","Select",""],["","68645054459","METFORMIN","HCL500MGTABLET","120","Select","Select",""],["","17478007035","ERYTHROMYCIN","0.005EYEOINTMENT","3.5","Select","Select",""],["","53489011802","DOXYCYCLINE","HYCLATE50MGCAP","60","Select","Select",""],["","31722099601","HYDROCODONE-ACETAMIN","5-325MG","12","Select","Select",""],["","61314063006","NEOMYC-POLYM-DEXAMETH","EYEDROP","5","Select","Select",""],["","69584061150","METHOCARBAMOL","500MGTABLET","20","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":""}]}]}