{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karen D Horn","gend":1,"add":"3860 Clark Rd SE","city":"Dalton","state":"GA","zip":30721,"dob":"1963-08-19","age":"","mstatus":"","insh":2507812001,"cliId":"","pno":7062178451,"cno":"","email":"bigcrazy_12@yahoo.com","ename":"","eno":"","pphy":"John Antalis","ppno":"","pcpadd":"1114 Professional Blvd","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":["M54.42","M54.41","M72.2","M79.671","M24.571","M77.51","M25.571","S93.401","Z20.828","R94.39","K21.9","E78.2","Z87.891","Z01.818","R94.31","Z00.01","M79.18","E78.1","Z12.31","D48.5","E04.9","E78.5","L65.9","M54.2","Z00.00","M25.561","R07.9","R06.00","R94.30","I25.41","U07.1","Z20.822","R05.1","R10.9","R07.89","R06.02","Z01.810","R10.10","M54.9","R19.7","R50.9","Z87.19","R12","R91.8","M47.812","Z80.8","Z80.3","Z80.41","Z09","R11.0","J01.81","B37.3","D17.1","K82.8","M54.6","K85.90","R10.13","M25.572","S93.402","E04.1","D17.0","R22.0"],"date":["2021-12-28","2021-12-28","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2021-08-03","2021-08-03","2021-04-27","2020-12-08","2021-07-27","2021-02-09","2020-12-08","2020-10-06","2021-02-09","2020-09-01","2020-09-01","2021-02-02","2021-09-28","2020-09-01","2021-07-13","2021-11-23","2020-04-21","2020-04-21","2020-09-01","2021-03-16","2021-11-09","2021-03-23","2021-03-23","2021-03-23","2021-12-14","2021-12-14","2021-12-14","2022-01-04","2021-02-09","2021-02-09","2020-11-17","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2020-04-09","2021-10-12","2021-10-12","2021-10-12","2021-11-30","2021-11-23","2020-02-11","2020-02-11","2020-09-08","2020-12-01","2021-05-11","2021-11-09","2021-11-09","2020-05-05","2020-05-05","2020-09-22","2020-09-29","2020-09-29"],"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":[["","555088704","ESTRADIOL","2MGTABLET","30","Select","Select",""],["","115552210","FENOFIBRATE","160MGTABLET","30","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","31722071390","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","143924920","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","72205002790","ROSUVASTATIN","CALCIUM5MGTAB","30","Select","Select",""],["","60432060416","PROMETHAZINE-DM","SYRUP","120","Select","Select",""],["","62175030232","RABEPRAZOLE","SODDR20MGTAB","60","Select","Select",""],["","143122701","DICYCLOMINE","20MGTABLET","28","Select","Select",""],["","55111014512","FLUCONAZOLE","150MGTABLET","2","Select","Select",""],["","49281042050","FLUZONE","QUAD2020-2021SYRINGE","0.5","Select","Select",""],["","70010077001","METHOCARBAMOL","750MGTABLET","30","Select","Select",""],["","68462015713","ONDANSETRON","ODT4MGTABLET","10","Select","Select",""],["","62332014131","CELECOXIB","100MGCAPSULE","60","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":""}]}]}