{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Natalie D Bellamy","gend":1,"add":"2 Brothers Ln","city":"Dalton","state":"GA","zip":30720,"dob":"1976-12-13","age":"","mstatus":"","insh":2111974001,"cliId":"","pno":7066181027,"cno":"","email":"ndawnwhite@yahoo.com","ename":"","eno":"","pphy":"Alejandra Staubs","ppno":"","pcpadd":"3957 Cleveland Hwy Ste B","pcpcity":"Dalton","pcpstate":"GA","pcpzip":"","pcpcounty":"Dalton","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"Apt 208","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":["Z01.419","Z13.31","Z12.39","D25.9","N93.9","E11.65","I10","Z79.899","J30.9","Z23","J45.909","R10.2","N72","D25.1","D25.2","N80.0","D27.1","N83.12","K21.9","E66.01","Z68.37","J01.90","J30.2","E11.9","J01.00","Z00.00","Z11.59","D64.9","N92.0","J30.1","J45.20","J20.9","R87.810","N93.8","N80.3","B34.9","J04.0","R03.0","R05"],"date":["2021-08-10","2021-08-10","2021-08-10","2020-07-21","2020-07-28","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2021-10-05","2020-09-22","2020-12-01","2021-04-06","2020-07-21","2020-07-28","2020-04-09","2020-05-05","2020-04-28","2020-04-28","2020-12-15","2020-06-09","2020-07-21","2020-07-21","2021-08-31","2021-08-31","2021-08-31","2020-12-15"],"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":[["","45802008801","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","378718705","METFORMIN","HCL1000MGTABLET","60","Select","Select",""],["","65862022660","CLARITHROMYCIN","500MGTABLET","7","Select","Select",""],["","57237004105","PENICILLIN","VK500MGTABLET","28","Select","Select",""],["","65862020299","LOSARTAN","POTASSIUM50MGTAB","45","Select","Select",""],["","406051201","OXYCODONE-ACETAMINOPHEN","5-325","30","Select","Select",""],["","49483060350","IBUPROFEN","600MGTABLET","30","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MGTABLET","7","Select","Select",""],["","67877021560","CEFUROXIME","AXETIL250MGTAB","14","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","60505083305","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","10702000310","PROMETHAZINE","25MGTABLET","20","Select","Select",""],["","65862017760","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","591544210","PREDNISONE","10MGTABLET","15","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":""}]}]}