{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charles Gilliland","gend":0,"add":"375 Yonah Post Rd","city":"Alto","state":"GA","zip":30510,"dob":"1970-02-24","age":"","mstatus":"","insh":2430741001,"cliId":"","pno":7067681314,"cno":"","email":"Charlesg333@gmx.com","ename":"","eno":"","pphy":"Thomas Yates","ppno":"","pcpadd":"163 Hospital Dr","pcpcity":"Toccoa","pcpstate":"GA","pcpzip":"","pcpcounty":"Toccoa","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":["N20.0","C61","D50.8","I10","E78.2","K31.1","G43.709","F51.01","K25.3","K31.0","Z68.24","K28.7","K29.30","N20.1","K21.9","D64.9","M19.90","M25.50","K43.9","K40.90","Z68.26","K25.5","R06.00","D72.825","Z11.59","Z79.899","N23","R31.0","N32.89","K40.20","Z00.00","R10.9","F17.290","R10.13","K26.7","Z98.890","Z90.3","J01.10","Z23","Z68.29","K31.84","K31.89","D72.829","T18.2XX","E87.2","I51.7","E03.9","G47.30","Z01.812","Z20.822","Z86.73","K28.9","Z90.710","H90.3","J90","L03.311","G45.9","K76.9","K42.9","R76.8","N28.1","Z68.27","Z68.23","K63.89","Z45.2","G89.18","R10.31","J30.2","R10.11","R23.8","N20.2","D72.819","A41.9","R79.89","R65.21","K63.2","T81.49X","B37.7","M25.511","G89.29","Z68.28","R11.2","R93.2","R94.31","B49","R07.89","M25.521","K27.5","R31.29","N28.89","K56.41","K65.1","R11.0","B37.9","I65.23","M32.9","N13.2","K31.5","K91.89","Z68.25"],"date":["2021-10-19","2020-08-04","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-25","2021-06-29","2021-06-29","2021-02-16","2021-12-14","2021-07-13","2020-04-14","2021-12-14","2020-05-26","2021-08-03","2020-05-26","2021-07-13","2021-07-13","2021-07-13","2020-06-09","2021-12-14","2021-10-19","2021-10-19","2021-08-05","2021-08-05","2021-09-28","2021-07-06","2020-03-17","2021-05-25","2021-05-25","2021-06-15","2021-05-25","2021-10-26","2021-10-26","2021-10-26","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-06-01","2021-05-04","2020-09-22","2021-07-13","2021-07-06","2021-07-06","2020-09-29","2020-09-29","2020-11-10","2020-06-30","2021-09-14","2020-11-03","2021-06-15","2021-06-15","2020-06-09","2021-08-03","2021-12-14","2021-08-03","2021-08-10","2021-12-14","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-07-13","2021-07-06","2021-07-06","2020-02-04","2020-02-04","2021-12-14","2021-05-25","2021-05-25","2021-05-25","2021-06-15","2021-05-25","2020-08-04","2021-07-20","2020-03-12","2021-06-15","2021-06-15","2021-07-06","2021-07-06","2021-06-29","2021-04-06","2020-08-04","2020-02-25","2021-06-01","2021-06-01","2021-03-30"],"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":[["","406012410","HYDROCODONE-ACETAMIN","7.5-325","20","Select","Select",""],["","70954000520","OXYBUTYNIN","5MGTABLET","30","Select","Select",""],["","16714065204","CIPROFLOXACIN","HCL500MGTAB","6","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","30","Select","Select",""],["","70010075405","METHOCARBAMOL","500MGTABLET","20","Select","Select",""],["","62175013643","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","59762219803","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","65162019011","NAPROXEN","500MGTABLET","60","Select","Select",""],["","43547035311","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","69367016304","PHENAZOPYRIDINE","200MGTAB","20","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","120","Select","Select",""],["","16714040102","CEFUROXIME","AXETIL500MGTAB","6","Select","Select",""],["","13107005501","OXYCODONE","HCL5MGTABLET","10","Select","Select",""],["","57896070310","IRON","65MGTABLET","30","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","10","Select","Select",""],["","80777027315","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","9","Select","Select",""],["","16714043901","NITROFURANTOIN","MONO-MCR100MG","10","Select","Select",""],["","10702000310","PROMETHAZINE","25MGTABLET","10","Select","Select",""],["","16714073201","CELECOXIB","100MGCAPSULE","60","Select","Select",""],["","65862018601","CLINDAMYCIN","HCL300MGCAPSULE","20","Select","Select",""],["","16714047802","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","143928501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TMP","DSTABLET","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":["",""]}},{"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":""}]}]}