{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GUADALUPE ESCUTIA","gend":1,"add":"123 Beverly SW Dr","city":"Rome","state":"GA","zip":30165,"dob":"1970-11-28","age":"","mstatus":"","insh":3622222001,"cliId":"","pno":7067667244,"cno":"","email":"ESCUTIAGUADALUPE611@YAHOO.COM","ename":"","eno":"","pphy":"Wilma Briones Mull","ppno":"","pcpadd":"1328 Joe Frank Harris Parkway SE","pcpcity":"Cartersville","pcpstate":"GA","pcpzip":"","pcpcounty":"Cartersville","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":["E11.65","G62.9","Z68.39","M25.561","M25.551","M25.512","M25.562","W19.XXX","S80.01X","S80.02X","S46.012","G56.01","J00","H92.02","M25.531","M25.631","M25.431","Z20.822","U07.1","M79.671","M72.2","M77.31","J12.82","R09.02","E87.5","R20.2","Z01.419","Z12.31","N95.2","R10.2","Z68.41","D24.2","N64.52","N64.4","R07.81","Z03.818","R09.81","R51.9","Z12.11","D12.2","Z68.38","G56.21","R20.8","L30.9","R05","J40","G61.0","M54.50","K58.9","R92.1","M17.12","J06.9","M79.604","M79.605","R60.0","J96.01","S92.532","Z20.828","G56.03","J02.9","M25.532","K63.5","E66.01","D24.1","Z12.39","K58.1"],"date":["2021-12-28","2022-01-06","2021-11-18","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2021-02-11","2021-10-05","2021-06-15","2021-02-11","2021-02-11","2021-02-11","2021-10-05","2022-01-06","2020-06-23","2020-06-23","2020-06-23","2021-12-28","2021-11-09","2021-11-18","2021-11-18","2021-02-11","2021-02-11","2021-02-11","2021-02-23","2021-11-09","2021-04-20","2021-04-20","2021-04-20","2021-11-23","2021-03-09","2021-11-09","2021-11-09","2021-03-30","2021-03-30","2022-01-06","2020-12-01","2020-10-20","2021-02-02","2020-08-18","2020-08-18","2021-12-28","2021-12-28","2021-11-09","2021-03-30","2020-04-09","2020-10-27","2021-12-08","2021-12-08","2021-10-20","2021-11-18","2021-08-31","2020-10-27","2020-11-10","2021-03-09","2020-11-10","2021-03-09","2021-03-09","2021-02-16","2021-02-16","2021-04-06"],"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":[["","60432060416","PROMETHAZINE-DM","SYRUP","200","Select","Select",""],["","68645056354","IBUPROFEN","800MGTABLET","30","Select","Select",""],["","67877021560","CEFUROXIME","AXETIL250MGTAB","14","Select","Select",""],["","68645058259","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","59746017509","PREDNISONE","20MGTABLET","5","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","20","Select","Select",""],["","54418625","DEXAMETHASONE","6MGTABLET","7","Select","Select",""],["","67877022310","GABAPENTIN","300MGCAPSULE","30","Select","Select",""],["","16571020150","DICLOFENAC","SODEC75MGTAB","30","Select","Select",""],["","31722094101","HYDROCODONE-ACETAMIN","5-325MG","20","Select","Select",""],["","10572030201","PEG","3350-ELECTROLYTESOLUTION","4000","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","42806031250","DOXYCYCLINE","HYCLATE100MGTAB","14","Select","Select",""],["","42192033901","HYOSCYAMINE","0.125MGTABSL","20","Select","Select",""],["","51862054001","BUTALB-ACETAMIN-CAFF","50-325-40","20","Select","Select",""],["","49281072110","FLUBLOK","QUAD2021-2022SYRINGE","0.5","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","20","Select","Select",""],["","168025846","CLOTRIMAZOLE-BETAMETHASONE","CRM","45","Select","Select",""],["","50383077504","LIDOCAINE","0.02VISCOUSSOLN","300","Select","Select",""],["","10702000709","CYCLOBENZAPRINE","10MGTABLET","15","Select","Select",""],["","65162019011","NAPROXEN","500MGTABLET","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":""}]}]}