{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Todd A Bowden","gend":0,"add":"3735 SW Ridge Bluff Overlook","city":"Gainesville","state":"GA","zip":30507,"dob":"1982-10-09","age":"","mstatus":"","insh":3673087001,"cliId":"","pno":4043048721,"cno":"","email":"toddabowden@gmail.com","ename":"","eno":"","pphy":"KOMMERINA DALING","ppno":"","pcpadd":"1400 River Pl","pcpcity":"Braselton","pcpstate":"GA","pcpzip":"","pcpcounty":"Braselton","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":["Z00.01","Z16.10","Z82.49","E55.9","D52.9","D51.9","E78.00","M79.10","R10.11","T46.6X5","R79.9","E29.1","E03.9","R53.83","E88.81","Z11.3","K76.0","Z20.828","F43.10","R53.81","F90.9","K59.04","K64.5","R74.8","L02.223","L28.0","L82.1","Z20.822","R03.0","R41.3","X58.XXX","I10","F33.1","F41.1","Z68.38","E07.1","F33.41","Z00.00","G47.33"],"date":["2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2020-08-04","2020-05-12","2020-05-12","2020-05-12","2021-03-02","2021-06-22","2021-03-02","2021-03-02","2021-06-22","2021-12-08","2021-02-02","2021-09-28","2021-05-25","2020-12-01","2020-12-01","2021-01-19","2021-01-19","2021-01-19","2021-02-23","2021-02-23","2021-02-23","2021-06-22","2021-12-08","2020-09-15","2020-09-15","2020-03-31","2020-03-31","2020-03-31","2020-03-31","2020-12-01","2021-01-12","2020-12-08","2020-12-08"],"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":[["","10702000310","PROMETHAZINE","25MGTABLET","30","Select","Select",""],["","60505016501","FLUVOXAMINE","MALEATE50MGTAB","30","Select","Select",""],["","70954002110","PRAZOSIN","5MGCAPSULE","30","Select","Select",""],["","47781049005","DOXYCYCLINE","HYCLATE100MGCAP","14","Select","Select",""],["","16714080701","DEXTROAMP-AMPHETAMIN","20MGTAB","90","Select","Select",""],["","68382009405","CARVEDILOL","12.5MGTABLET","60","Select","Select",""],["","16729013716","CLONAZEPAM","1MGTABLET","30","Select","Select",""],["","16714045301","QUETIAPINE","FUMARATE50MGTAB","30","Select","Select",""],["","16714098801","ROSUVASTATIN","CALCIUM5MGTAB","30","Select","Select",""],["","169413602","OZEMPIC","1MGDOSEPEN","3","Select","Select",""],["","16714078301","ARIPIPRAZOLE","2MGTABLET","30","Select","Select",""],["","68180097103","LEVOTHYROXINE","125MCGTABLET","30","Select","Select",""],["","185061505","HYDROXYZINE","PAM50MGCAP","60","Select","Select",""],["","591024205","LORAZEPAM","2MGTABLET","15","Select","Select",""],["","16714033002","GABAPENTIN","600MGTABLET","90","Select","Select",""],["","62756018488","OXCARBAZEPINE","300MGTABLET","60","Select","Select",""],["","42192033901","HYOSCYAMINE","0.125MGTABSL","40","Select","Select",""],["","43547035311","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","23155010210","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","54092047701","MYDAYIS","ER50MGCAPSULE","30","Select","Select",""],["","45802006405","TRIAMCINOLONE","0.001CREAM","454","Select","Select",""],["","29300013505","CLONIDINE","HCL0.1MGTABLET","60","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMIN","5-325MG","12","Select","Select",""],["","65862018830","ONDANSETRON","HCL8MGTABLET","24","Select","Select",""],["","59762374401","CLINDAMYCIN","PHOSP0.01LOTION","60","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","14","Select","Select",""],["","59267100002","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","66685100100","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","65064835","TOBRADEX","EYEOINTMENT","3.5","Select","Select",""],["","10631040701","PROCTOSOL-HC","0.025CREAM","28.35","Select","Select",""],["","33332032001","AFLURIA","QUAD2020-21(3YRUP)","0.5","Select","Select",""],["","16714049601","CLOTRIMAZOLE-BETAMETHASONE","CRM","15","Select","Select",""],["","68462022301","LITHIUM","CARBONATEER300MGTB","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":""}]}]}