{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pamela Klemm","gend":1,"add":"2713 Northlake Rd","city":"Gainesville","state":"GA","zip":30506,"dob":"1966-08-20","age":"","mstatus":"","insh":3742038001,"cliId":"","pno":6783154198,"cno":"","email":"klemm2131@bellsouth.net","ename":"","eno":"","pphy":"ELLEN SANDERS","ppno":"","pcpadd":"4222 Fairbanks Dr","pcpcity":"Oakwood","pcpstate":"GA","pcpzip":"","pcpcounty":"Oakwood","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":["G47.9","R53.83","R41.0","N95.1","E55.9","E53.8","Z13.21","Z12.31","G43.909","Z20.822","M25.511","G89.29","G43.109","Z68.41","M79.89","Z79.890","E87.1","R73.03","Z85.820","Z20.828","Z01.419","M79.672","Z00.00","Z13.89","M19.011","R51.9","J01.00","R05","R09.81","L03.116","R73.9","L03.90","L81.2","L82.1","D22.5","D18.01","M79.662","J40","L20.9","L50.9","R00.0","J02.9","M62.830","M54.5","C43.62","R11.0","I80.02","R60.9","Z23","L81.0","G47.00","R63.5","L65.9","Z88.5","Z98.890","R22.42"],"date":["2020-04-09","2020-04-09","2020-04-09","2020-04-09","2021-10-19","2020-04-09","2020-04-09","2021-05-18","2021-09-28","2021-09-28","2021-07-13","2021-07-13","2021-10-19","2021-10-19","2020-09-01","2021-03-30","2020-09-08","2020-09-08","2020-10-06","2020-09-08","2020-04-09","2020-06-16","2021-10-19","2021-10-19","2021-11-16","2021-06-29","2020-10-06","2020-10-06","2020-10-06","2020-09-08","2020-09-08","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2021-12-21","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-08-11","2020-08-11","2020-05-12","2021-05-25","2020-09-22","2020-09-08","2021-10-26","2020-09-15","2020-03-24","2020-03-24","2020-03-24","2020-09-08","2020-09-08","2020-09-01"],"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":[["","65862052730","VENLAFAXINE","HCLER37.5MGCAP","30","Select","Select",""],["","67877026218","RIZATRIPTAN","10MGTABLET","9","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","93031401","KETOROLAC","10MGTABLET","20","Select","Select",""],["","51991081701","PROPRANOLOL","ER60MGCAPSULE","30","Select","Select",""],["","527293341","PREDNISONE","10MGTABLET","21","Select","Select",""],["","781217660","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","42806054701","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","378464226","ESTRADIOL","0.05MGPATCH","8","Select","Select",""],["","52817033010","CYCLOBENZAPRINE","5MGTABLET","30","Select","Select",""],["","69452023320","PROGESTERONE","100MGCAPSULE","30","Select","Select",""],["","61442010305","DICLOFENAC","SODDR75MGTAB","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","28","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","28","Select","Select",""],["","472037915","CLOTRIMAZOLE-BETAMETHASONE","CRM","15","Select","Select",""],["","68382024701","BENZONATATE","100MGCAPSULE","20","Select","Select",""],["","51672131200","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","14","Select","Select",""],["","57237007530","ONDANSETRON","HCL4MGTABLET","21","Select","Select",""],["","68462040601","INDOMETHACIN","25MGCAPSULE","30","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":""}]}]}