{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERTHILA VASQUEZ","gend":1,"add":"1119 Eagle Eye Rd","city":"Gainesville","state":"GA","zip":30504,"dob":"1965-07-16","age":"","mstatus":"","insh":3842714001,"cliId":"","pno":6784687010,"cno":"","email":"BERTHILAVASQUEZ@YAHOO.COM","ename":"","eno":"","pphy":"HUMA SOHAIL","ppno":"","pcpadd":"961A Smoky Mountain Springs Lane","pcpcity":"Gainesville","pcpstate":"GA","pcpzip":"","pcpcounty":"Gainesville","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"Apt 1119","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":["E51.8","D50.9","R53.82","Z20.828","J02.9","R53.83","R09.81","R50.9","G89.4","M25.50","Z79.891","Z51.81","M25.572","E55.9","E78.5","M54.16","E66.9","Z68.31","Z20.822","Z79.899","U07.1","J96.01","J12.89","M51.26","M19.90","M48.07","M54.40","R79.9","E11.9","E78.2","M54.5","H25.13","H04.123","M05.9","H52.4","M17.11","M25.561","R68.83","M47.816","Z00.00","M06.4","R76.8","M25.562","Z78.0","E78.1","J30.81","J30.89","J30.1","J20.9","R06.2","Z01.818","M54.50","M48.061","Z12.31","A41.9","J90","R91.8","D64.9","R09.02","Z13.29","M51.36","M43.16","Z68.30","M51.27","M47.817","M17.9"],"date":["2020-11-10","2021-11-02","2021-11-02","2020-07-14","2021-11-09","2021-11-09","2021-11-09","2020-07-14","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-02-23","2021-11-02","2021-11-02","2021-12-14","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2020-10-06","2020-10-06","2020-10-06","2021-12-07","2020-10-06","2020-10-13","2020-05-26","2020-09-15","2020-10-06","2021-11-02","2021-09-14","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-06-29","2021-09-28","2021-11-09","2021-05-04","2020-12-15","2021-09-28","2021-09-21","2020-11-10","2020-01-22","2021-11-02","2020-06-23","2020-06-23","2020-06-23","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-12-14","2020-11-24","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-12-08","2020-09-08","2020-06-09","2021-09-21","2021-09-07","2021-09-07","2021-09-14"],"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":[["","59762010402","SULFASALAZINE","DR500MGTAB","180","Select","Select",""],["","904759080","FERROUS","SULFATE325MGTABLET","30","Select","Select",""],["","65162010250","GABAPENTIN","300MGCAPSULE","120","Select","Select",""],["","93720298","PRAVASTATIN","SODIUM40MGTAB","30","Select","Select",""],["","68382009601","HYDROXYCHLOROQUINE","200MGTAB","60","Select","Select",""],["","555057202","METHOTREXATE","2.5MGTABLET","28","Select","Select",""],["","70954005930","PREDNISONE","10MGTABDOSEPACK","21","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","140","Select","Select",""],["","11534016503","FOLIC","ACID1MGTABLET","30","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","16571020150","DICLOFENAC","SODEC75MGTAB","30","Select","Select",""],["","406051205","OXYCODONE-ACETAMINOPHEN","5-325","40","Select","Select",""],["","69097014260","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","70010075401","METHOCARBAMOL","500MGTABLET","30","Select","Select",""],["","66685100100","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","52817033200","CYCLOBENZAPRINE","10MGTABLET","20","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","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":""}]}]}