{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Julie Coats","gend":1,"add":"1037 Regency Park Dr","city":"Braselton","state":"GA","zip":30517,"dob":"1962-09-10","age":"","mstatus":"","insh":3834194001,"cliId":"","pno":6789979231,"cno":"","email":"juliebabettekell@aol.com","ename":"","eno":"","pphy":"Satish Poddar","ppno":"","pcpadd":"289 Grayson Highway,N","pcpcity":"Lawrenceville","pcpstate":"GA","pcpzip":"","pcpcounty":"Lawrenceville","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":["R07.89","Q39.6","R42","I11.0","I50.9","J44.9","I25.2","K04.7","R25.2","E78.00","M19.90","Z87.891","Z95.5","Z20.828","R05","M79.10","J39.2","L54","I25.10","N39.0","K57.90","J20.9","G89.29","M25.512","G47.33","K42.9","R07.9","F43.10","R73.03","I10","R60.0","J02.9","R11.2","R19.7","Z87.19","Z20.822","Z82.49","Z88.0","Z88.5","Z79.82","I25.110","I25.5","M54.2","R11.0","E78.49","E66.01","R63.4","Z68.41","Z80.3","Z79.899","R51","J45.20","R06.02","E78.5","G62.9","R20.2","I89.0","F41.9","E55.9","E53.8","Z79.890","K22.5","R13.19","R55","J40","S39.011","R10.32","J44.0","F41.1","M79.671","M79.672","M72.2","G60.3","L85.3","J01.41","R09.82","J43.9","M50.323","K59.00","R13.10","E78.2","K21.9","R91.8","R51.9","G47.09","G25.81","J06.9","F32.9","G47.00","K57.30","M79.89","I50.22","J44.1","R63.8","R06.2","J98.11","J20.8","Z53.29","I20.0","R94.31","R68.89","R09.89","R41.0","R53.83","E66.9","J30.2","I63.9","R21","S39.012","H72.02","F32.89","Z77.120","I11.9","Z71.3","R60.9","Z87.820","R44.0","J01.80","M54.5","M62.838","J01.90","R11.10","R10.13","J38.5","R49.0"],"date":["2021-07-13","2021-05-04","2021-07-20","2021-12-14","2021-12-14","2021-11-23","2021-12-14","2020-12-29","2020-12-08","2021-02-11","2021-12-14","2021-12-14","2021-12-14","2020-12-08","2021-07-06","2020-08-18","2020-08-18","2020-08-18","2021-12-14","2021-12-28","2021-07-06","2021-07-06","2021-08-17","2021-08-17","2021-06-22","2021-09-07","2021-11-30","2021-07-06","2021-04-06","2021-12-28","2021-12-28","2020-10-06","2020-10-06","2020-10-06","2020-10-13","2021-07-13","2021-12-14","2021-07-13","2021-07-13","2021-07-13","2020-10-13","2021-12-14","2020-10-20","2021-12-14","2021-12-14","2021-06-15","2020-10-06","2021-06-15","2021-12-14","2020-10-06","2020-10-06","2020-11-24","2021-09-07","2021-07-13","2021-09-28","2021-10-20","2020-05-26","2021-04-27","2021-10-20","2021-06-22","2021-04-06","2021-05-04","2020-12-08","2021-02-11","2021-12-14","2021-12-14","2021-12-28","2021-12-14","2021-01-12","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2021-06-08","2021-06-22","2021-06-22","2020-10-06","2021-07-13","2021-05-04","2021-06-15","2021-10-20","2021-06-22","2021-07-13","2021-07-13","2021-07-13","2020-12-15","2021-04-27","2021-10-20","2021-09-07","2020-05-26","2021-06-15","2021-06-15","2021-06-15","2021-06-29","2021-09-07","2021-07-06","2021-06-08","2020-10-20","2021-07-20","2020-11-03","2020-11-17","2020-12-15","2020-11-24","2020-06-30","2020-06-30","2021-04-06","2021-05-18","2021-04-06","2020-10-06","2021-10-20","2021-06-29","2020-10-06","2021-05-04","2020-04-28","2020-06-30","2020-06-30","2020-06-30","2020-09-22","2020-09-22","2020-09-22","2021-05-04","2021-05-04","2020-12-15","2020-12-15"],"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":[["","69097040707","METOPROLOL","SUCCER50MGTAB","30","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","43547028111","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","13668042990","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","16729011917","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","68001032205","BUPROPION","HCLXL150MGTABLET","30","Select","Select",""],["","69452014330","BENZONATATE","100MGCAPSULE","21","Select","Select",""],["","185067401","HYDROXYZINE","PAM25MGCAP","20","Select","Select",""],["","59762453802","MEDROXYPROGESTERONE","150MG\/ML","1","Select","Select",""],["","69680011225","CYANOCOBALAMIN","1000MCG\/ML","1","Select","Select",""],["","51862033301","ESTRADIOL","1MGTABLET","30","Select","Select",""],["","310461612","BREZTRI","AEROSPHEREINHALER","10.7","Select","Select",""],["","16729017101","AMITRIPTYLINE","HCL10MGTAB","30","Select","Select",""],["","71093014005","METHOCARBAMOL","500MGTABLET","6","Select","Select",""],["","781107710","ALPRAZOLAM","0.5MGTABLET","2","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","65862053820","LEVOFLOXACIN","750MGTABLET","7","Select","Select",""],["","57237016999","ROSUVASTATIN","CALCIUM10MGTAB","15","Select","Select",""],["","50111056001","TRAZODONE","50MGTABLET","7","Select","Select",""],["","68001042300","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","43598034901","PROGESTERONE","100MGCAPSULE","30","Select","Select",""],["","65862020199","LOSARTAN","POTASSIUM25MGTAB","30","Select","Select",""],["","93720198","PRAVASTATIN","SODIUM20MGTAB","30","Select","Select",""],["","13668009490","PRAMIPEXOLE","1MGTABLET","90","Select","Select",""],["","70461032003","FLUCELVAX","QUAD2020-2021SYR","0.5","Select","Select",""],["","65862017760","CEFDINIR","300MGCAPSULE","14","Select","Select",""],["","68462063945","NITROGLYCERIN","0.4MGTABLETSL","25","Select","Select",""],["","72511076002","REPATHA","140MG\/MLSURECLICK","2","Select","Select",""],["","68180096301","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","54004544","IPRATROPIUM","0.0003SPRAY","30","Select","Select",""],["","68462019005","NAPROXEN","500MGTABLET","15","Select","Select",""],["","69618004610","ASPIRIN","EC81MGTABLET","30","Select","Select",""],["","68382032010","POTASSIUM","CLER10MEQTABLET","30","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","50228018005","GABAPENTIN","300MGCAPSULE","30","Select","Select",""],["","59746017306","PREDNISONE","10MGTABLET","20","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","10","Select","Select",""],["","68001016208","PROMETHAZINE","25MGTABLET","15","Select","Select",""],["","60505083001","MOMETASONE","FUROATE50MCGSPRY","17","Select","Select",""],["","54429731","FUROSEMIDE","20MGTABLET","30","Select","Select",""],["","591024001","LORAZEPAM","0.5MGTABLET","30","Select","Select",""],["","65862018730","ONDANSETRON","HCL4MGTABLET","12","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","173086910","ANORO","ELLIPTA62.5-25MCGINH","60","Select","Select",""],["","60505083305","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMIN","5-325MG","8","Select","Select",""],["","43547035310","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","66689000816","NYSTATIN","100000UNIT\/MLSUSP","160","Select","Select",""],["","591565810","CYCLOBENZAPRINE","10MGTABLET","14","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","300","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","14","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","14","Select","Select",""],["","121085416","SULFATRIM","PEDIATRICSUSPENSION","280","Select","Select",""],["","16729020001","BUSPIRONE","HCL5MGTABLET","180","Select","Select",""],["","527128201","DICYCLOMINE","20MGTABLET","20","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":""}]}]}