{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lilia Aguirre","gend":1,"add":"5412 Lawson Robinson Rd","city":"Gainesville","state":"GA","zip":30506,"dob":"1977-08-08","age":"","mstatus":"","insh":3693507001,"cliId":"","pno":6789437444,"cno":"","email":"lilycap28@yahoo.com","ename":"","eno":"","pphy":"Michael Mulberry","ppno":"","pcpadd":"23 Tipton Dr","pcpcity":"Dahlonega","pcpstate":"GA","pcpzip":"","pcpcounty":"Dahlonega","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":["F33.2","F32.9","R53.83","R31.21","Z01.411","Z11.3","Z00.01","E55.9","Z13.89","E53.8","Z83.3","Z68.27","L20.9","Z12.31","Z00.00","Z23","R23.2","R21","J30.89","R07.89","G44.209","H92.03","Z20.822","N95.1","J02.9","R39.9","N30.00","N64.4","Z68.26","J06.9","G47.9","Z68.28","R63.8","R09.81","R05","R51.9","H92.09","R10.31","Z86.2","J30.1","Z01.419","R31.0","N30.01","L71.0","R31.29","R52","N39.3"],"date":["2020-11-24","2020-11-24","2021-12-28","2021-09-28","2020-11-17","2020-11-17","2021-08-10","2021-12-28","2021-08-10","2021-12-28","2021-08-10","2021-12-28","2021-08-10","2021-12-28","2021-07-27","2021-08-10","2020-08-11","2021-09-07","2021-09-07","2021-12-28","2021-12-28","2021-12-28","2021-03-16","2021-10-19","2021-04-13","2022-01-04","2022-01-04","2020-10-27","2020-08-11","2021-10-19","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-10-19","2021-12-28","2021-10-19","2020-11-17","2021-05-25","2021-05-25","2021-11-09","2021-07-27","2021-07-27","2021-06-15"],"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":[["","51293081001","PHENAZOPYRIDINE","100MGTAB","6","Select","Select",""],["","555089902","ESTRADIOL","0.5MGTABLET","30","Select","Select",""],["","68180018001","CEFADROXIL","500MGCAPSULE","20","Select","Select",""],["","143992801","CIPROFLOXACIN","HCL500MGTAB","8","Select","Select",""],["","70069000510","CYANOCOBALAMIN","1000MCG\/ML","1","Select","Select",""],["","50222030350","FINACEA","0.15FOAM","50","Select","Select",""],["","50228043605","NAPROXEN","500MGTABLET","30","Select","Select",""],["","65162055610","TEMAZEPAM","15MGCAPSULE","30","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","118","Select","Select",""],["","68462029817","CLOTRIMAZOLE-BETAMETHASONE","CRM","15","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","143928501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","13811071910","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","591405289","IVERMECTIN","0.01CREAM","45","Select","Select",""],["","66993081530","DOXYCYCLINE","IR-DR40MGCAP","30","Select","Select",""],["","68025008330","DIVIGEL","0.75MGGELPACKET","30","Select","Select",""],["","68382091634","METHYLPREDNISOLONE","4MGDOSEPK","21","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":""}]}]}