{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Steven Phillips","gend":0,"add":"1127 Arlo Todd Road","city":"Toccoa","state":"GA","zip":30577,"dob":"1964-08-18","age":"","mstatus":"","insh":4086149001,"cliId":"","pno":7066585356,"cno":"","email":"stevenphillips08181964@gmail.com","ename":"","eno":"","pphy":"Kalpesh Mistry","ppno":"","pcpadd":"1025 Falls Rd","pcpcity":"Toccoa","pcpstate":"GA","pcpzip":"","pcpcounty":"Toccoa","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":["E11.42","I10","L97.529","L97.526","M86.9","E11.52","L97.429","L97.419","I70.263","E87.1","L03.116","E11.65","Z79.4","E11.69","N17.9","I12.9","E11.22","N18.9","E78.00","D63.8","G47.30","R00.1","T50.995","E11.628","U07.1","R09.02","E83.41","Z45.2","S91.302","E11.621","I25.118","I36.1","D41.01","R91.8","R53.1","B95.2","B96.89","I70.209","I25.10","Z95.1","N18.32","E66.01","Z48.01","L97.522","C64.1","E11.351","E55.9","D41.00","Z12.11","K63.5","R11.0","R06.02","R10.9","Z20.828","Z87.891","Z87.442","I50.32","R63.8","H25.13","E11.359","E11.9","E78.49","Z79.899","Z12.5","Z00.00","E87.5","R80.0","I13.0","Z68.41","N18.30","D64.9","G47.33","K21.9","E11.51","I50.9","I65.23","N18.3","E78.2","Z68.42","Z99.89","F17.200","Z79.02","Z79.82","Z89.422","R73.9","N20.0","M47.896","Z51.81","L97.929","R22.42","D62","F17.210","D69.6","Z98.890","D12.0","D12.5","K64.8","R53.81","R53.83","N18.4","R80.9","D63.1","Z90.5","H43.12","I11.0","M47.817","M47.816","D21.0","M86.172","J98.4","N28.89","N32.89","K42.9","L97.423","L97.413","I70.244","I70.234","M86.671","M86.372","D41.20","I25.110","J12.82","J96.01","E87.3","E86.0","R19.7","R80.8","K30","R74.8","E87.8","E78.1","E11.29","I50.33","I73.9","L97.829","E13.65","R39.198","F33.1","Z00.01","L97.822","R05","R07.9","M51.36","Z79.891","M15.0","Z73.6","M51.17","M47.27","R60.0","J98.11","M86.672","I50.23","Z01.818","R60.9","R09.89","I13.10","N18.2","E11.21","M86.472","R03.0","I27.20","J18.9","R11.2","M19.071","R22.41","L97.521"],"date":["2021-04-06","2021-12-28","2020-07-21","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-10-06","2020-10-27","2021-06-08","2020-10-27","2021-06-08","2021-03-23","2020-10-27","2021-08-31","2021-06-08","2021-12-21","2021-06-08","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-03-23","2021-02-02","2021-06-08","2020-07-07","2020-06-02","2021-11-23","2020-09-08","2020-09-08","2021-04-06","2021-04-20","2021-06-08","2020-03-17","2020-03-17","2020-03-17","2021-11-30","2020-03-17","2021-10-19","2021-10-20","2020-08-04","2020-08-04","2021-10-20","2021-01-19","2021-10-05","2021-05-04","2021-03-23","2021-03-23","2021-06-08","2021-02-02","2021-02-02","2021-03-16","2021-10-06","2021-01-26","2021-11-30","2021-11-30","2021-01-19","2021-01-19","2021-10-05","2021-10-05","2021-12-28","2021-10-05","2021-10-05","2021-10-19","2021-12-21","2021-03-23","2021-06-08","2021-03-23","2021-03-23","2021-10-06","2021-10-06","2021-03-23","2021-03-23","2021-10-06","2020-09-29","2021-10-20","2021-11-23","2021-03-16","2020-01-21","2020-01-21","2020-01-21","2020-03-12","2021-03-23","2021-10-20","2020-12-29","2021-12-28","2020-03-12","2020-03-12","2020-02-11","2020-02-11","2020-02-11","2020-02-04","2020-09-08","2020-09-08","2020-09-08","2020-07-21","2020-07-21","2021-12-21","2021-10-19","2021-10-19","2021-12-21","2020-12-01","2021-10-20","2020-10-13","2021-12-28","2020-09-01","2020-05-19","2021-03-16","2021-06-08","2021-01-26","2021-01-26","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2021-03-09","2020-02-11","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-10-06","2021-10-20","2020-05-19","2021-03-02","2021-01-12","2021-11-02","2021-10-06","2020-07-21","2021-02-11","2021-02-02","2021-12-28","2021-12-28","2020-10-20","2020-10-20","2021-06-29","2021-06-29","2021-12-21","2020-02-04","2020-05-05","2021-04-06","2021-03-09","2021-10-19","2020-02-11","2020-02-11","2021-04-13","2021-03-09","2020-05-05","2021-11-23","2021-11-23","2021-02-02","2021-02-02","2021-08-24","2021-08-24","2020-07-07"],"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":[["","68180072003","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","70377002811","ATORVASTATIN","20MGTABLET","30","Select","Select",""],["","68462016305","CARVEDILOL","6.25MGTABLET","60","Select","Select",""],["","43547040211","FUROSEMIDE","40MGTABLET","5","Select","Select",""],["","2871501","HUMULIN","70-30VIAL","30","Select","Select",""],["","65862035705","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","62011001902","HM","ASPIRINEC81MGTABLET","30","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","378456105","POTASSIUM","CLER10MEQTABLET","30","Select","Select",""],["","603388732","HYDROCODONE-ACETAMIN","10-325MG","90","Select","Select",""],["","53885024510","ONETOUCH","ULTRABLUETESTSTRP","100","Select","Select",""],["","60505014201","GLIPIZIDE","10MGTABLET","60","Select","Select",""],["","65862018730","ONDANSETRON","HCL4MGTABLET","12","Select","Select",""],["","10702000310","PROMETHAZINE","25MGTABLET","10","Select","Select",""],["","52817036100","METOPROLOL","TARTRATE50MGTAB","60","Select","Select",""],["","53436008430","VELTASSA","8.4GMPOWDERPACKET","30","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","50111032803","HYDRALAZINE","50MGTABLET","90","Select","Select",""],["","68180037709","LOSARTAN","POTASSIUM50MGTAB","30","Select","Select",""],["","904675180","ASPIRIN","EC81MGTABLET","30","Select","Select",""],["","42858010450","OXYCODONE-ACETAMINOPHEN","10-325","90","Select","Select",""],["","16714061205","SERTRALINE","HCL50MGTABLET","30","Select","Select",""],["","8290328466","BD","INSSYRUF0.5ML12.7MMX30G","100","Select","Select",""],["","68462018022","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","10572030201","PEG","3350-ELECTROLYTESOLUTION","4000","Select","Select",""],["","68382013210","TAMSULOSIN","HCL0.4MGCAPSULE","30","Select","Select",""],["","61314062810","POLYMYXIN","B-TMPEYEDROPS","10","Select","Select",""],["","10702003615","SODIUM","POLYSTYRENESULFPOWDER","60","Select","Select",""],["","378415105","TRAMADOL","HCL50MGTABLET","50","Select","Select",""],["","62175061746","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","16714065102","CIPROFLOXACIN","HCL250MGTAB","24","Select","Select",""],["","16714039102","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","58160082311","SHINGRIX","VIALKIT","1","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MGTABLET","10","Select","Select",""],["","60758011910","PREDNISOLONE","AC0.01EYEDROP","10","Select","Select",""],["","43386009019","GAVILYTE-G","SOLUTION","4000","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":""}]}]}