{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maria A Rivero","gend":1,"add":"8 Spring St","city":"Gainesville","state":"GA","zip":30501,"dob":"1964-12-15","age":"","mstatus":"","insh":4072624001,"cliId":"","pno":7706340888,"cno":"","email":"riverom213@gmail.com","ename":"","eno":"","pphy":"NORA ROMERO MIRANDA","ppno":"","pcpadd":"115 Towne Center Parkway,Suite 11","pcpcity":"Hoschton","pcpstate":"GA","pcpzip":"","pcpcounty":"Hoschton","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":["C50.812","Z17.1","Z68.28","Z51.11","T78.40X","R11.0","T45.1X5","I11.9","R06.02","E78.49","I38","Z17.0","K21.9","K31.7","K62.1","C50.912","R92.8","Z68.29","L03.90","I10","N63.25","R59.0","K61.0","Z85.3","Z80.1","Z80.51","Z80.0","Z80.42","M54.50","C50.412","R25.1","T40.425","E87.6","I34.1","Z79.01","Z87.19","Z20.822","Z80.3","Z86.010","K63.5","I77.810","F41.1","E66.8","R53.83","R14.0","R10.84","R12","D70.1","E78.2","E03.8","E66.3","F41.8","Z71.89","Z68.31","R22.1","K59.03","N63.24","I89.8","M25.50","Z68.27","K64.1","S34.119","L03.315","R92.1","Z01.419","Z12.31","M54.42","Z79.899","E66.09","Z68.32","M89.9","Z12.11","D12.8","M51.26","Z13.31","R91.8","Z01.818","E07.9","C50.312","K64.8","K29.70","M54.6","E03.9","R60.0","M25.552","M25.551","F41.9","R11.2","G47.00","T50.905","K62.89"],"date":["2022-01-04","2022-01-04","2021-10-19","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-12-28","2021-06-08","2021-11-30","2021-10-26","2022-01-04","2021-12-07","2021-08-10","2021-08-10","2021-11-30","2021-10-26","2021-08-17","2021-02-02","2021-12-07","2021-06-29","2021-07-27","2020-05-26","2021-11-16","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-12-28","2022-01-04","2021-11-02","2021-12-08","2021-12-08","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-02-11","2021-02-11","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-07","2021-12-07","2021-12-07","2021-09-21","2021-09-01","2021-09-01","2021-06-08","2021-08-24","2020-05-26","2020-05-26","2021-09-14","2021-09-21","2021-07-06","2021-07-06","2021-12-28","2021-12-28","2021-10-12","2021-11-09","2020-05-12","2021-06-29","2021-01-19","2021-04-06","2021-11-09","2021-05-25","2021-05-25","2021-05-25","2021-12-07","2021-02-02","2021-02-02","2021-11-02","2021-09-28","2021-07-20","2021-10-26","2021-11-30","2021-10-26","2021-02-02","2021-02-02","2021-12-14","2021-12-07","2021-05-25","2021-12-28","2021-12-28","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-02-23"],"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":[["","69238183007","LEVOTHYROXINE","25MCGTABLET","30","Select","Select",""],["","50111043302","TRAZODONE","50MGTABLET","30","Select","Select",""],["","68382001801","VENLAFAXINE","HCL25MGTABLET","30","Select","Select",""],["","378023110","ATENOLOL","50MGTABLET","30","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","68180072003","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","16729018201","HYDROCHLOROTHIAZIDE","12.5MGTB","30","Select","Select",""],["","51862094205","DIAZEPAM","5MGTABLET","1","Select","Select",""],["","42858010201","OXYCODONE-ACETAMINOPHEN","5-325","20","Select","Select",""],["","62037099901","POTASSIUM","CLER20MEQTABLET","15","Select","Select",""],["","31722088290","ROSUVASTATIN","CALCIUM5MGTAB","30","Select","Select",""],["","378668999","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","57237000511","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","59746000314","METHYLPREDNISOLONE","16MGTAB","4","Select","Select",""],["","59746011506","PROCHLORPERAZINE","10MGTAB","30","Select","Select",""],["","781107710","ALPRAZOLAM","0.5MGTABLET","45","Select","Select",""],["","50458057830","XARELTO","15MGTABLET","28","Select","Select",""],["","406012405","HYDROCODONE-ACETAMIN","7.5-325","20","Select","Select",""],["","65162052110","PROMETHAZINE","25MGTABLET","10","Select","Select",""],["","52817033010","CYCLOBENZAPRINE","5MGTABLET","60","Select","Select",""],["","93005301","BUSPIRONE","HCL5MGTABLET","60","Select","Select",""],["","65162006205","SUCRALFATE","1GM\/10MLSUSP","1200","Select","Select",""],["","67877032105","IBUPROFEN","800MGTABLET","30","Select","Select",""],["","378623201","CITALOPRAM","HBR20MGTABLET","30","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","14","Select","Select",""],["","713050324","ANUCORT-HC","25MGSUPPOSITORY","20","Select","Select",""],["","93314705","CEPHALEXIN","500MGCAPSULE","21","Select","Select",""],["","58160082311","SHINGRIX","VIALKIT","1","Select","Select",""],["","31722052001","HYDRALAZINE","25MGTABLET","60","Select","Select",""],["","591207030","LIDOCAINE-PRILOCAINE","CREAM","30","Select","Select",""],["","68462010630","ONDANSETRON","HCL8MGTABLET","15","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","28","Select","Select",""],["","29300013510","CLONIDINE","HCL0.1MGTABLET","30","Select","Select",""],["","45802011846","MOMETASONE","FUROATE0.001SOLN","60","Select","Select",""],["","37682210","PROCTOFOAM-HC","1%-1%FOAM","10","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":""}]}]}