{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Shelley m Keller","gend":1,"add":"3251 Springdale Forrest Cir","city":"Gainesville","state":"GA","zip":30506,"dob":"1972-11-22","age":"","mstatus":"","insh":3806569002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"CRYSTAL TERRILL","ppno":"","pcpadd":"1400 River Place","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":["N92.1","D25.2","Z30.09","Z68.30","N93.8","Z30.430","N90.89","R32","N92.0","F10.10","F19.20","J02.9","H65.02","E66.9","L60.0","R51","R09.81","L60.8","Z30.2","Z87.891","H83.02","H60.8X3","E34.8","E66.8","B97.89","Z68.33","Z00.00","R39.89","M54.5","R63.8","R11.0","Z03.818","Z30.432","N30.01","F34.89","R42","F41.9","N91.2","Z12.31","Z71.89","Z11.59","B35.3","L60.3","M79.671","M79.672","J06.9","Z20.822","Z68.32","J01.90","H66.91","B96.89","H92.03","L29.9","L30.9","E66.3","I10","Z01.818","F33.0","Z68.28","N92.4","R10.2","Z30.431","H92.01"],"date":["2021-10-05","2021-10-05","2021-09-14","2021-09-14","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2021-02-02","2021-08-10","2020-04-28","2021-07-13","2021-07-06","2021-08-10","2021-07-06","2020-07-07","2020-07-07","2021-08-05","2021-10-05","2021-10-05","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2021-04-20","2021-08-10","2021-04-20","2021-04-20","2021-08-10","2021-04-20","2020-07-07","2021-01-26","2021-01-12","2021-01-12","2021-08-10","2021-10-26","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-05-18","2021-05-25","2021-02-02","2020-07-07","2020-07-07","2020-07-07","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-09-28","2021-10-26","2021-10-26","2020-06-16","2020-06-16","2020-06-16","2020-06-02"],"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":[["","781217660","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","527293537","PREDNISONE","50MGTABLET","5","Select","Select",""],["","16729008110","NALTREXONE","50MGTABLET","30","Select","Select",""],["","781185220","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","472037945","CLOTRIMAZOLE-BETAMETHASONE","CRM","45","Select","Select",""],["","406048401","ACETAMINOPHEN-COD","#3TABLET","12","Select","Select",""],["","69918030130","TRANEXAMIC","ACID650MGTABLET","30","Select","Select",""],["","65853302","CIPRODEX","OTICSUSPENSION","7.5","Select","Select",""],["","70010049101","METFORMIN","HCLER500MGTABLET","60","Select","Select",""],["","64380071306","BENZONATATE","200MGCAPSULE","42","Select","Select",""],["","68462015713","ONDANSETRON","ODT4MGTABLET","20","Select","Select",""],["","13668013710","ESCITALOPRAM","20MGTABLET","30","Select","Select",""],["","555077902","MEDROXYPROGESTERONE","10MGTAB","10","Select","Select",""],["","51991074710","DULOXETINE","HCLDR30MGCAP","30","Select","Select",""],["","65162046650","IBUPROFEN","800MGTABLET","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":""}]}]}