{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Freeman H Floyd","gend":0,"add":"1 Coral Ave SW","city":"Rome","state":"GA","zip":30161,"dob":"1973-08-03","age":"","mstatus":"","insh":3822012001,"cliId":"","pno":4044415344,"cno":"","email":"onecreativefhf@gmail.com","ename":"","eno":"","pphy":"Heather Pryor","ppno":"","pcpadd":"1825 Martha Berry Boulevard NW","pcpcity":"Rome","pcpstate":"GA","pcpzip":"","pcpcounty":"Rome","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":["B20","J01.90","I10","K21.9","E66.9","F32.9","Z68.26","Z21","M25.552","M16.12","Z96.642","M87.052","R19.7","Z68.28","G47.00","K29.60","J30.89","Z00.00","Z00.01","R93.89","R53.83","R53.81","E55.9","R68.89","Z20.828","B02.9","M79.675","Z68.29","Z47.1","J30.1","Z23","F41.9","Z96.632","Z79.01","Z91.81","M65.331","M65.351","J02.9","M62.838","M25.519","Z96.641","Z68.30","M87.051"],"date":["2021-11-18","2021-08-24","2021-07-13","2021-07-13","2020-01-21","2020-01-21","2020-01-21","2020-01-21","2020-02-25","2020-02-25","2020-03-03","2021-07-13","2021-12-14","2021-12-08","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-22","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-22","2021-10-26","2021-10-26","2021-10-26","2020-02-25","2021-11-18","2021-11-18","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-07-14","2020-07-14","2020-02-11","2020-02-11","2020-02-11","2020-03-03","2020-03-03","2020-02-11"],"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":[["","65162019010","NAPROXEN","500MGTABLET","60","Select","Select",""],["","59651000305","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","61958190101","GENVOYA","TABLET","30","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","31722072610","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","62559049001","DIPHENOXYLATE-ATROP","2.5-0.025","15","Select","Select",""],["","68382079101","ACYCLOVIR","400MGTABLET","60","Select","Select",""],["","406012510","HYDROCODONE-ACETAMIN","10-325MG","60","Select","Select",""],["","43547038450","GABAPENTIN","300MGCAPSULE","60","Select","Select",""],["","68001000501","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","703854023","ENOXAPARIN","40MG\/0.4MLSYR","4","Select","Select",""],["","47335077991","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","45802028139","TESTOSTERONE","1.62%(1.25G)PKT","37.5","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","68001036500","METRONIDAZOLE","500MGTABLET","21","Select","Select",""],["","65862001501","AMOXICILLIN","875MGTABLET","20","Select","Select",""],["","68180016013","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","55111012705","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","378427577","VALACYCLOVIR","HCL500MGTABLET","42","Select","Select",""],["","43386048024","ORPHENADRINE","ER100MGTABLET","60","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":""}]}]}