{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Terri A Fitch","gend":1,"add":"1295 Morgan Valley Rd","city":"Rockmart","state":"GA","zip":30153,"dob":"1966-05-20","age":"","mstatus":"","insh":3683247001,"cliId":"","pno":4048597624,"cno":"","email":"terrifitch@me.com","ename":"","eno":"","pphy":"JULAINE CROSS","ppno":"","pcpadd":"11766 Hwy 27 N","pcpcity":"Summerville","pcpstate":"GA","pcpzip":"","pcpcounty":"Summerville","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":["M54.5","R29.898","M54.2","G89.4","G43.909","M25.511","G89.29","M54.42","J34.2","J34.3","M47.26","M62.830","R20.2","Z51.89","F17.211","Z20.822","Z12.31","M46.1","F41.8","E66.9","M48.02","M50.30","M47.816","E05.90","E04.1","N32.89","R10.11","M54.16","Z79.891","K86.89","E04.2","R73.9","R63.5","K92.1","M85.80","M19.90","Q89.01","D37.4","K64.8","Z12.11","R20.0","K80.10","Z11.59","Z85.3","Z68.30","Z13.6","M25.551","M25.552","R05","F41.0","R53.83","F31.9","R10.9","M54.41","H93.13","J30.89","H69.83","H90.72","J34.89","H90.41","M47.27","K59.09","R76.0","M79.7","R19.4","M25.559","S49.91X","E05.20","R68.89","R79.89","M47.812","M54.12","K82.8","Z90.411","K63.5","K57.30","K64.9","F32.9","M25.50","G57.61","L25.9","K81.1","J20.9","D12.4","D49.2","M79.671","M79.672","K86.9","R22.41","E07.9","G43.109","L30.9","M51.37","R52","Z04.3","G43.119"],"date":["2021-04-13","2021-04-20","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-07","2021-10-19","2021-09-21","2021-09-21","2021-05-18","2021-04-20","2021-10-19","2021-10-19","2021-06-15","2021-09-21","2021-08-24","2021-12-07","2021-10-26","2021-03-23","2021-10-05","2020-09-01","2021-07-27","2020-06-30","2020-07-14","2021-12-28","2021-10-26","2020-09-01","2020-09-01","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-05-26","2020-05-26","2020-05-19","2021-05-18","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2021-07-27","2021-11-23","2021-09-02","2021-08-31","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2021-12-07","2021-09-14","2021-09-14","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-05-18","2020-07-14","2021-11-02","2021-11-02","2020-05-12","2021-12-28","2021-12-28","2020-07-21","2021-10-12","2020-05-05","2021-02-16","2021-12-28","2020-08-11","2020-06-09","2020-12-01","2020-12-01","2020-12-01","2021-07-27","2021-07-27","2021-07-27","2021-05-04","2020-06-23","2021-11-09","2020-05-26","2021-10-06","2021-10-06","2021-08-05","2020-06-16","2021-10-12","2021-05-11","2021-09-14","2021-04-27","2021-08-10","2021-08-10","2021-12-21","2021-07-20"],"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":[["","33332031901","AFLURIA","QUAD2019-20(3YRUP)","0.5","Select","Select",""],["","456120130","LINZESS","145MCGCAPSULE","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","14","Select","Select",""],["","603548221","PROPRANOLOL","10MGTABLET","60","Select","Select",""],["","59746017210","PREDNISONE","5MGTABLET","21","Select","Select",""],["","31722099601","HYDROCODONE-ACETAMIN","5-325MG","30","Select","Select",""],["","68462015713","ONDANSETRON","ODT4MGTABLET","10","Select","Select",""],["","65162019011","NAPROXEN","500MGTABLET","60","Select","Select",""],["","68645013054","FLUOXETINE","HCL20MGCAPSULE","30","Select","Select",""],["","43199001301","HYOSCYAMINE","SULF0.125MGTAB","30","Select","Select",""],["","65162037110","OXYBUTYNIN","CLER5MGTABLET","30","Select","Select",""],["","72618300002","NURTEC","ODT75MGTABLET","8","Select","Select",""],["","62332012190","PREGABALIN","75MGCAPSULE","90","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","68382000810","LAMOTRIGINE","100MGTABLET","30","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","49281072010","FLUBLOK","QUAD2020-2021SYRINGE","0.5","Select","Select",""],["","55513084101","AIMOVIG","70MG\/MLAUTOINJECTOR","1","Select","Select",""],["","52817032150","BACLOFEN","20MGTABLET","60","Select","Select",""],["","23650110","UBRELVY","100MGTABLET","10","Select","Select",""],["","68180096301","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","45802006435","TRIAMCINOLONE","0.001CREAM","15","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":""}]}]}