{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Francine B Ware","gend":1,"add":"110 Coker Drive","city":"Rome","state":"GA","zip":30165,"dob":"1972-03-31","age":"","mstatus":"","insh":3996085001,"cliId":"","pno":7064433531,"cno":"","email":"fware4348@gmail.com","ename":"","eno":"","pphy":"JOSHUA WICKSTROM","ppno":"","pcpadd":"32 Roundtree Dr","pcpcity":"Piedmont","pcpstate":"AL","pcpzip":"","pcpcounty":"Piedmont","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":["N60.12","N60.11","R07.9","F17.210","J43.9","I10","E78.5","K21.9","Z79.82","Z79.84","R53.1","R42","E11.9","Z28.21","E11.65","N64.4","R19.7","Z87.891","N89.8","Z11.3","Z13.31","N17.9","E86.0","D75.1","F14.10","F12.10","F32.9","Z79.4","E11.329","H25.13","E87.1","E11.40","Z91.19","N63.13","R00.1","R94.31","R73.9","N61.0","B37.3","N64.89","R92.2","R07.1","G80.9","J44.9","F17.200","G62.9","M54.5","M99.01","M99.02","M99.07","B37.9","R07.89","M79.602","E11.69","E66.9","G44.209","M99.09","G56.00","M79.10","N61.1","F41.9","N63.15","N63.11","N63.21","M54.2","R11.2","I49.8","M54.12","M62.838","L29.9","R10.11"],"date":["2021-09-14","2021-09-14","2021-09-23","2021-09-23","2021-09-23","2021-12-07","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-06-15","2021-06-15","2021-12-14","2021-12-14","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-07-27","2021-08-05","2021-07-27","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-08-03","2021-05-25","2021-07-27","2021-07-27","2021-05-11","2021-05-11","2021-05-11","2021-12-14","2021-09-14","2021-09-28","2021-11-16","2021-11-16","2021-11-16","2022-01-04","2022-01-04","2021-09-14","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-08-10","2021-08-10","2021-12-14","2021-12-14","2021-09-28","2021-09-21","2021-09-21","2021-09-21","2021-12-07","2021-08-03","2021-08-17","2021-08-17","2021-08-17","2021-09-14","2021-11-23","2021-05-04","2021-08-10","2021-08-10","2021-08-10","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":[["","31722070290","LOSARTAN","POTASSIUM100MGTAB","30","Select","Select",""],["","55111014512","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","93505898","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","143992701","CIPROFLOXACIN","HCL250MGTAB","10","Select","Select",""],["","68180044601","QUETIAPINE","FUMARATE50MGTAB","30","Select","Select",""],["","68382005005","MELOXICAM","7.5MGTABLET","7","Select","Select",""],["","88221905","LANTUS","SOLOSTAR100UNIT\/ML","15","Select","Select",""],["","59651000330","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","169406012","VICTOZA","2-PAK18MG\/3MLPEN","6","Select","Select",""],["","70010010810","GABAPENTIN","100MGCAPSULE","120","Select","Select",""],["","55111017915","TIZANIDINE","HCL2MGTABLET","56","Select","Select",""],["","67877025130","TRIAMCINOLONE","0.001CREAM","30","Select","Select",""],["","31722094201","HYDROCODONE-ACETAMIN","7.5-325","12","Select","Select",""],["","597015230","JARDIANCE","10MGTABLET","30","Select","Select",""],["","16729018201","HYDROCHLOROTHIAZIDE","12.5MGTB","30","Select","Select",""],["","69097084507","CYCLOBENZAPRINE","5MGTABLET","42","Select","Select",""],["","168014630","HYDROCORTISONE","0.025OINTMENT","28.3","Select","Select",""],["","63304069301","CLINDAMYCIN","HCL300MGCAPSULE","15","Select","Select",""],["","70010077001","METHOCARBAMOL","750MGTABLET","90","Select","Select",""],["","2751001","HUMALOG","100UNIT\/MLVIAL","10","Select","Select",""],["","55111015330","ONDANSETRON","HCL4MGTABLET","24","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}