{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kristy M Haley","gend":1,"add":"4206 Wood Acres Rd","city":"Oakwood","state":"GA","zip":30566,"dob":"1983-05-18","age":"","mstatus":"","insh":4135988001,"cliId":"","pno":6783813903,"cno":"","email":"kristy.haley@yahoo.com","ename":"","eno":"","pphy":"Christina Nguyen","ppno":"","pcpadd":"1439 Jesse Jewell Parkway,Suite 30","pcpcity":"Gainesville","pcpstate":"GA","pcpzip":"","pcpcounty":"Gainesville","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":["R41.840","Z79.899","E78.5","Z68.32","E66.9","F32.9","F90.9","M19.90","M25.50","R51.9","R53.83","R06.00","Z72.0","K04.7","I10","J45.909","E11.9","F17.210","F17.290","H92.09","J06.9","K03.81","J02.9","R05","R31.9","E11.65","Z68.37","R06.02","F17.200","L65.9","R51","R61","Z68.36","M79.642","M79.641","G56.32","G56.31","M79.631","M79.632","H00.012","Z01.419","Z23","R09.81","Z71.3","L21.8","L81.1","L57.8","R82.5","Z01.89","Z87.442","K52.9","F98.8","Z68.35"],"date":["2021-12-28","2021-12-28","2021-12-28","2020-08-11","2021-12-28","2021-02-23","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-02-23","2020-04-21","2020-04-21","2020-04-21","2021-06-29","2020-04-21","2020-04-21","2020-04-21","2021-12-21","2020-04-21","2021-11-23","2021-03-30","2020-07-21","2021-12-28","2021-08-24","2021-02-23","2021-06-01","2020-08-11","2020-08-11","2020-08-11","2021-06-29","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-06-08","2021-06-08","2021-03-09","2020-08-11","2021-05-18","2021-02-02","2021-03-23","2022-01-06","2022-01-06","2022-01-06","2021-08-24","2021-11-23","2021-05-04","2021-05-04","2021-05-04","2021-05-04"],"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":[["","527150237","DEXTROAMP-AMPHETAMIN","10MGTAB","30","Select","Select",""],["","55111012105","ATORVASTATIN","10MGTABLET","30","Select","Select",""],["","45802046564","KETOCONAZOLE","0.02SHAMPOO","120","Select","Select",""],["","68462053253","CLOBETASOL","0.0005SOLUTION","50","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","20","Select","Select",""],["","13811071910","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","406012301","HYDROCODONE-ACETAMIN","5-325MG","10","Select","Select",""],["","68462010805","TOPIRAMATE","25MGTABLET","30","Select","Select",""],["","65162010250","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","68382024701","BENZONATATE","100MGCAPSULE","21","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","65162068090","PROMETHAZINE-DM","6.25-15MG\/5ML","140","Select","Select",""],["","378247401","DICLOFENAC","POT50MGTABLET","40","Select","Select",""],["","67877025520","CEPHALEXIN","750MGCAPSULE","14","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":""}]}]}