{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carmalita a Castaneda","gend":1,"add":"795 US Highway 82 W Lot 543","city":"Leesburg","state":"GA","zip":31763,"dob":"1980-05-30","age":"","mstatus":"","insh":3974373001,"cliId":"","pno":6623477497,"cno":"","email":"carmalita1915@gmail.com","ename":"","eno":"","pphy":"Brittany Stalvey","ppno":"","pcpadd":"725 US Highway 19 S,N","pcpcity":"Camilla","pcpstate":"GA","pcpzip":"","pcpcounty":"Camilla","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":["I10","T81.32X","Z95.1","I21.4","I25.10","I11.9","R94.31","Z95.5","I50.32","F17.210","E11.65","E66.01","Z68.38","E03.8","Z72.0","I25.2","I25.5","E11.9","G62.89","F41.8","Z03.818","M54.5","N92.5","N83.292","E87.1","I25.718","Z20.822","E03.9","Z79.899","Z79.4","Z79.82","Z79.891","Z79.890","E78.5","E66.9","I25.118","Z68.39","Z09","R10.9","K59.00","R11.2","F17.200","Z98.61","E11.69","T81.89X","Z12.73","I51.7","N28.1","N85.4","J90","J98.11","K76.0","R16.0","I70.0","Z68.37","J96.01","E66.2","E78.2","R07.89"],"date":["2021-10-19","2021-10-19","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-28","2021-09-22","2021-08-17","2021-08-17","2021-12-28","2021-12-28","2021-12-28","2021-09-07","2021-07-20","2021-08-10","2021-08-10","2021-08-03","2021-08-03","2021-08-03","2021-08-24","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-07-20","2021-07-20","2021-06-15","2021-06-15","2021-06-15","2021-08-24","2021-09-22","2021-09-22","2021-06-15","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-08-24","2021-06-29","2021-06-29","2021-06-29","2021-09-02","2021-08-24","2021-08-24","2021-07-27","2021-07-13"],"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":[["","72305010030","EUTHYROX","100MCGTABLET","30","Select","Select",""],["","13668000701","ZOLPIDEM","TARTRATE5MGTABLET","30","Select","Select",""],["","310620530","FARXIGA","5MGTABLET","30","Select","Select",""],["","13668010401","ISOSORBIDE","MONONITER30MGTB","30","Select","Select",""],["","93505798","ATORVASTATIN","80MGTABLET","30","Select","Select",""],["","31722099601","HYDROCODONE-ACETAMIN","5-325MG","15","Select","Select",""],["","68645058359","METFORMIN","HCL850MGTABLET","60","Select","Select",""],["","68645055154","LISINOPRIL","5MGTABLET","15","Select","Select",""],["","57237010099","METOPROLOL","TARTRATE25MGTAB","60","Select","Select",""],["","67877022310","GABAPENTIN","300MGCAPSULE","30","Select","Select",""],["","81131013834","RELION","INSSYR1ML31GX15\/64","100","Select","Select",""],["","43598044828","NICOTINE","21MG\/24HRPATCH","28","Select","Select",""],["","47781064690","LEVOTHYROXINE","75MCGTABLET","30","Select","Select",""],["","12843053642","LOW","DOSEASPIRINEC81MGTAB","27","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MGTABLET","21","Select","Select",""],["","57237001830","DULOXETINE","HCLDR30MGCAP","30","Select","Select",""],["","68645059090","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","20","Select","Select",""],["","536123201","ASPIRIN","EC325MGTABLET","30","Select","Select",""],["","88222033","LANTUS","100UNIT\/MLVIAL","10","Select","Select",""],["","55111028130","LEVOFLOXACIN","750MGTABLET","10","Select","Select",""],["","228202750","ALPRAZOLAM","0.25MGTABLET","22","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":""}]}]}