{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbra Kitchens","gend":1,"add":"10193 Zebulon Road","city":"Forsyth","state":"GA","zip":31029,"dob":"1971-08-27","age":"","mstatus":"","insh":3673659002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Laurie Cochran","ppno":"","pcpadd":"120 N Lee St,Suite ","pcpcity":"Forsyth","pcpstate":"GA","pcpzip":"","pcpcounty":"Forsyth","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":["F10.220","R79.89","R74.8","E83.52","E87.1","E87.5","F10.10","M47.896","M43.00","Z20.822","F31.9","K74.60","I95.9","S81.811","W19.XXX","R94.5","D12.4","D12.0","D12.2","K70.30","I85.00","K76.6","K31.89","K64.8","Z80.0","R10.9","R68.81","R09.89","R41.82","N17.9","E72.20","F17.200","K42.9","Z09","K80.20","R30.0","F32.9","R81","Z12.11","I85.10","F17.210","K63.5","N19","E87.6","F29","G93.41","N39.0","R25.8","S81.001","R06.02","F10.229","F41.9","M54.5","S39.92X","R56.9","D50.9","F41.1","F10.20","X58.XXX","R50.9","R60.0","F43.0","H65.00","Y92.009","R42"],"date":["2021-07-27","2021-07-27","2020-10-06","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-07-06","2021-07-06","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-07-06","2021-07-06","2021-04-20","2021-07-06","2021-07-06","2021-07-06","2021-11-09","2021-07-06","2021-11-09","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2022-01-06","2021-10-26","2021-10-26","2021-07-13","2021-04-27","2021-04-27","2021-04-27","2021-11-09","2021-09-22","2021-09-22","2021-09-22","2021-06-15","2021-05-04","2021-05-04","2021-05-04","2021-12-28","2021-09-22","2021-09-22","2021-09-22","2021-10-13","2021-09-01","2021-07-20","2021-07-06","2021-07-27","2021-09-07","2021-07-13","2021-07-13","2021-09-01","2021-10-06","2021-03-30","2021-03-30","2021-06-22","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-06-29","2021-07-13"],"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":[["","16729020301","BUSPIRONE","HCL15MGTABLET","90","Select","Select",""],["","16729014601","QUETIAPINE","FUMARATE50MGTAB","30","Select","Select",""],["","43547040211","FUROSEMIDE","40MGTABLET","30","Select","Select",""],["","65862057490","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","59267100003","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","16729008110","NALTREXONE","50MGTABLET","30","Select","Select",""],["","245531711","KLOR-CON","M10TABLET","10","Select","Select",""],["","51991074890","DULOXETINE","HCLDR60MGCAP","30","Select","Select",""],["","50111056001","TRAZODONE","50MGTABLET","30","Select","Select",""],["","406012305","HYDROCODONE-ACETAMIN","5-325MG","12","Select","Select",""],["","143992801","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","69315090601","LORAZEPAM","2MGTABLET","6","Select","Select",""],["","55111015330","ONDANSETRON","HCL4MGTABLET","10","Select","Select",""],["","45963043864","ENULOSE","10GM\/15MLSOLUTION","473","Select","Select",""],["","69452015020","VALPROIC","ACID250MGCAPSULE","60","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","14","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","49483060450","IBUPROFEN","800MGTABLET","30","Select","Select",""],["","24658031205","DOXYCYCLINE","HYCLATE100MGTAB","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}