{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sharon Long","gend":1,"add":"5522 Hair Lake Rd","city":"Summerville","state":"GA","zip":30747,"dob":"1958-01-07","age":"","mstatus":"","insh":3959240001,"cliId":"","pno":7068578342,"cno":"","email":"brookenz.long@gmail.com","ename":"","eno":"","pphy":"RAYMOND JARVIS","ppno":"","pcpadd":"330 Turner McCall Blvd,Suite 300","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":["G47.33","E66.9","G43.909","M15.9","G47.00","G25.81","Z68.26","H25.812","R31.1","G89.4","Z68.28","Z87.442","N20.1","N20.0","N13.2","M54.5","F44.9","F33.9","H91.93","Z68.29","H26.9","H26.491","Z01.419","Z12.31","Z79.899","F41.9","R53.81","R73.01","S39.012","H81.13","H60.543","J30.9","H69.83","H90.3","J12.82","R31.9","M25.551","M48.9","G43.011","Z96.1","H35.313","U07.1","J18.9","R51.9","R11.2","R05.9","F43.12","R14.0","E78.5","Z68.27"],"date":["2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-12-08","2021-05-18","2021-02-16","2021-11-09","2021-05-04","2021-11-18","2021-05-04","2021-08-05","2021-11-09","2021-05-04","2021-04-20","2021-11-23","2021-12-16","2021-12-16","2021-11-23","2021-03-09","2021-02-11","2021-02-11","2021-04-27","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-06-15","2021-04-13","2021-04-13","2021-12-08","2021-03-09","2021-04-13","2021-12-28","2021-03-16","2021-12-08","2021-12-08","2021-12-08","2021-02-16","2021-02-16","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-11-18","2021-06-01","2021-12-16","2021-12-16"],"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":[["","62559014901","ESTROGEN-METHYLTESTOS","F.S.TAB","30","Select","Select",""],["","23155060601","GLYCOPYRROLATE","1MGTABLET","60","Select","Select",""],["","51991074890","DULOXETINE","HCLDR60MGCAP","30","Select","Select",""],["","60505384901","CELECOXIB","200MGCAPSULE","30","Select","Select",""],["","69097012503","TOPIRAMATE","200MGTABLET","30","Select","Select",""],["","65862057490","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","536123441","ASPIRIN","EC81MGTABLET","14","Select","Select",""],["","68462010530","ONDANSETRON","HCL4MGTABLET","10","Select","Select",""],["","62756052169","SUMATRIPTAN","SUCC50MGTABLET","9","Select","Select",""],["","24658031205","DOXYCYCLINE","HYCLATE100MGTAB","20","Select","Select",""],["","42858010401","OXYCODONE-ACETAMINOPHEN","10-325","20","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMIN","5-325MG","20","Select","Select",""],["","228202950","ALPRAZOLAM","0.5MGTABLET","30","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","20","Select","Select",""],["","168000615","TRIAMCINOLONE","0.001OINTMENT","30","Select","Select",""],["","47781030301","NITROFURANTOIN","MONO-MCR100MG","20","Select","Select",""],["","75826011510","PHENAZOPYRIDINE","200MGTAB","30","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","10","Select","Select",""],["","68180016011","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","57237001401","TAMSULOSIN","HCL0.4MGCAPSULE","7","Select","Select",""],["","378064205","PREDNISONE","20MGTABLET","5","Select","Select",""],["","69584061250","METHOCARBAMOL","750MGTABLET","30","Select","Select",""],["","603459315","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","68180030360","CEFUROXIME","AXETIL500MGTAB","14","Select","Select",""],["","80777027398","MODERNA","COVID-19VACCINE(EUA)","0.5","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":""}]}]}