{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beverly Hawkins","gend":1,"add":"1830 Beaverdale Rd NE","city":"Dalton","state":"GA","zip":30721,"dob":"1966-02-05","age":"","mstatus":"","insh":2423908001,"cliId":"","pno":7062642852,"cno":"","email":"bjhawkins3@yahoo.com","ename":"","eno":"","pphy":"JAMES ZUPPA","ppno":"","pcpadd":"102 N Oaks Dr","pcpcity":"Dalton","pcpstate":"GA","pcpzip":"","pcpcounty":"Dalton","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":["E03.9","E11.9","E78.5","I10","K90.9","R53.83","Z79.899","J30.89","J20.9","J15.9","R05","J30.81","H53.453","H02.831","H02.834","H04.131","J18.9","R06.2","J98.4","J32.0","J32.1","J30.1","J34.89","K21.9","D64.9","G47.33","Z20.828","M54.2","R20.0","R51","Z79.84","J18.1","H10.45","R21","L29.9","L50.8","M67.40","Z91.018","L50.1","Z01.419","R30.0","R91.1","R05.3","J30.2","Z68.41","Z03.89","R07.89","R42","E78.2","E66.01","E03.4","K21.0","R19.7","L30.8","Z00.00","J31.0","R68.89","J01.00","H65.03","D23.5","D22.61","T78.09X","R13.19","M47.892","S09.90X","V49.9XX","R10.12","R31.0","S39.92X","S29.9XX","I63.9","R07.0","E66.9","D48.5","L82.0","Z85.828","L50.9","D22.5","D18.01","L82.1","I83.90","D23.9","I78.9","Z12.31","L23.0","L25.9","K76.0","R07.9","L30.9","L20.9","F42.4","N20.0","M54.89","M79.644","M06.341","L98.9","R11.0","R20.2","Z04.1","I77.1","K21.00","L85.3"],"date":["2021-07-20","2021-07-20","2021-07-20","2022-01-06","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-05-25","2021-05-25","2021-07-13","2022-01-06","2021-12-28","2022-01-04","2022-01-04","2022-01-04","2021-12-14","2020-11-10","2021-12-14","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-12-14","2021-07-20","2021-12-14","2020-10-06","2020-04-28","2020-03-17","2020-03-17","2020-03-17","2020-10-27","2021-01-12","2020-06-09","2020-06-09","2021-11-30","2021-02-16","2021-01-12","2022-01-06","2021-06-15","2020-11-24","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2020-10-27","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2020-09-29","2021-07-20","2020-08-11","2020-03-24","2020-01-28","2020-02-25","2020-02-25","2020-02-25","2020-10-06","2020-10-06","2020-07-28","2020-12-15","2020-03-03","2020-03-03","2020-03-10","2021-10-19","2021-10-19","2020-03-10","2020-03-10","2020-03-10","2020-10-27","2020-06-30","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2021-08-24","2020-02-18","2020-05-12","2021-05-04","2020-10-06","2020-08-04","2020-06-09","2020-06-09","2021-10-19","2020-04-28","2021-04-27","2021-04-27","2021-02-02","2021-07-20","2020-03-17","2020-03-12","2020-03-10","2021-01-26","2020-03-03"],"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":[["","62756014202","METFORMIN","HCLER500MGTABLET","60","Select","Select",""],["","70710101002","OSELTAMIVIR","PHOS75MGCAPSULE","10","Select","Select",""],["","51525029403","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","68180096703","LEVOTHYROXINE","75MCGTABLET","30","Select","Select",""],["","68462026290","ROSUVASTATIN","CALCIUM10MGTAB","30","Select","Select",""],["","13668008105","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","169413212","OZEMPIC","0.25-0.5MGDOSEPEN","1.5","Select","Select",""],["","832532515","POTASSIUM","CLER20MEQTABLET","30","Select","Select",""],["","527293437","PREDNISONE","20MGTABLET","10","Select","Select",""],["","173088210","BREO","ELLIPTA200-25MCGINH","60","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","57664037718","TRAMADOL","HCL50MGTABLET","12","Select","Select",""],["","65162099208","DOTTI","0.0375MGPATCH","8","Select","Select",""],["","51672128202","TRIAMCINOLONE","0.001CREAM","30","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","64380071307","BENZONATATE","200MGCAPSULE","30","Select","Select",""],["","50383004316","HYDROCODONE-HOMATROPINE","SYRUP","120","Select","Select",""],["","93227534","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","65862017760","CEFDINIR","300MGCAPSULE","10","Select","Select",""],["","67877021905","CEPHALEXIN","500MGCAPSULE","30","Select","Select",""],["","143992801","CIPROFLOXACIN","HCL500MGTAB","20","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","54004641","IPRATROPIUM","0.0006SPRAY","15","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","68001025320","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","781223410","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","172392770","DIAZEPAM","10MGTABLET","1","Select","Select",""],["","68462022517","MOMETASONE","FUROATE0.001OINT","60","Select","Select",""],["","51672135203","DESOXIMETASONE","0.0005OINTMENT","60","Select","Select",""],["","57237003105","AMOXICILLIN","500MGCAPSULE","30","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","7","Select","Select",""],["","93598627","EPINEPHRINE","0.3MGAUTO-INJECT","2","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","14","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":""}]}]}