{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"brandie a carroll","gend":1,"add":"626Roland hayes pkwy sw","city":"calhoun","state":"GA","zip":30701,"dob":"1978-03-30","age":"","mstatus":"","insh":2302527001,"cliId":"","pno":7062638729,"cno":"","email":"carrollbrandie99@gmail.com","ename":"","eno":"","pphy":"Jay Thomas","ppno":"","pcpadd":"304 Turner McCall Boulevard SW","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":["L28.2","R61","N30.01","N89.8","J02.0","B34.9","R07.9","R42","R11.0","M25.512","R63.0","F17.290","R09.81","R51.9","Z68.24","M50.322","M47.812","M54.6","M43.26","M54.5","G89.4","M79.18","M96.1","M54.2","Z79.891","S02.2XX","N30.00","F41.8","F17.210","Z82.49","M79.10","J01.90","R50.9","R53.1","R53.83","R06.02","J34.89","N39.0","M50.30","U07.1","J32.4","R19.7","F41.9","N95.1","Z13.29","S09.92X","M46.1","M79.605","M79.2","K21.9","J34.2","F43.22","M43.02","M54.50","R07.89","S00.33X"],"date":["2021-09-21","2021-09-21","2021-04-20","2021-02-02","2021-08-17","2021-10-20","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-26","2021-10-26","2021-10-19","2021-02-11","2021-04-06","2021-02-11","2022-01-06","2021-10-06","2022-01-06","2021-11-09","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2021-02-02","2021-04-27","2021-05-04","2021-04-20","2022-01-06","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-06-29","2021-10-06","2021-10-26","2021-05-04","2021-04-06","2021-04-06","2021-04-27","2021-04-20","2021-12-28","2022-01-06","2021-10-06","2021-11-09","2021-09-28","2021-12-28","2021-04-27","2021-12-08","2022-01-06","2021-10-20","2022-01-06"],"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":[["","64980041509","PREGABALIN","200MGCAPSULE","42","Select","Select",""],["","55111018010","TIZANIDINE","HCL4MGTABLET","90","Select","Select",""],["","185012201","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","58657045101","PHENAZOPYRIDINE","200MGTAB","12","Select","Select",""],["","10702000310","PROMETHAZINE","25MGTABLET","60","Select","Select",""],["","27808003502","HYDROCODONE-ACETAMIN","5-325MG","10","Select","Select",""],["","93915701","VENLAFAXINE","HCL75MGTABLET","30","Select","Select",""],["","67877026410","DULOXETINE","HCLDR30MGCAP","30","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","120","Select","Select",""],["","29300012510","MELOXICAM","15MGTABLET","14","Select","Select",""],["","69547035302","NARCAN","4MGNASALSPRAY","2","Select","Select",""],["","65862001130","SERTRALINE","HCL25MGTABLET","45","Select","Select",""],["","57237009960","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","70752013005","TRIAMCINOLONE","0.001LOTION","60","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","42858000201","OXYCODONE","HCL(IR)10MGTAB","105","Select","Select",""],["","16571066401","METRONIDAZOLE","500MGTABLET","14","Select","Select",""],["","53489012005","DOXYCYCLINE","HYCLATE100MGTAB","20","Select","Select",""],["","59762219803","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","59651002675","AMOX-CLAV","250-62.5MG\/5MLSUS","100","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","57237000511","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","31722071390","PANTOPRAZOLE","SODDR40MGTAB","30","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":""}]}]}