{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jodie E Dixon","gend":1,"add":"5250 Couch Rd","city":"Flowery Branch","state":"GA","zip":30542,"dob":"1962-07-10","age":"","mstatus":"","insh":4148829001,"cliId":"","pno":5613198022,"cno":"","email":"prissyjo12@gmail.com","ename":"","eno":"","pphy":"Jessica Snyder","ppno":"","pcpadd":"4919 Atlanta Hwy","pcpcity":"Flowery Branch","pcpstate":"GA","pcpzip":"","pcpcounty":"Flowery Branch","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":["R11.10","K52.9","K57.30","K64.8","K59.04","K21.9","D50.9","R65.10","M79.7","Z11.59","M19.90","F41.9","Z90.49","Z98.84","G89.29","E87.6","D72.829","R18.8","Z79.899","Z82.49","Z87.891","Z88.1","Z01.84","R10.13","J90","J98.11","N39.0","D50.8","R10.9","E55.9","D63.1","L59.0","D22.71","I78.8","Z08","Z85.828","D48.5","D64.9","R10.84","N18.31","I10","Z68.26","Z12.31","R11.2","Z90.710","R10.12","M54.5","R03.0","E53.8","R00.0","Z00.01","M54.17","R13.14","M51.14","M47.23","E66.3","M47.816","F41.8","Z68.25","R92.8","D62","Z76.89","F19.10","Z68.24","M54.14","M54.6","M51.16","M47.27","N20.2","R13.10","R41.82","R10.10","R11.0","I16.9","Z23","D10.6","L72.0","Z00.00","F41.1","R53.83","F50.89","Z12.39","R19.7","D50.0","K57.90","Z03.818","R82.4","K22.2","Z98.0","B02.9","K59.09","N64.89"],"date":["2021-04-20","2021-04-20","2021-02-09","2021-02-09","2021-02-09","2021-06-15","2021-02-11","2021-02-09","2021-06-15","2021-09-21","2021-04-27","2021-02-09","2021-04-27","2021-06-15","2021-02-09","2021-04-20","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-05-18","2021-02-09","2021-09-21","2021-08-17","2020-08-11","2020-08-11","2021-06-08","2021-06-08","2021-06-08","2021-06-15","2021-06-08","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-08-11","2021-06-15","2020-11-17","2021-09-21","2021-12-07","2021-07-20","2021-06-15","2020-08-11","2021-05-25","2021-05-25","2021-05-25","2021-05-18","2021-05-25","2020-11-03","2021-09-21","2021-06-15","2020-11-10","2020-11-10","2021-04-20","2021-06-15","2021-02-02","2021-09-21","2021-07-20","2020-12-15","2021-04-27","2021-04-27","2021-06-15","2021-09-21","2020-11-03","2020-11-10","2020-11-10","2020-10-13","2021-06-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2021-09-21","2020-06-16","2020-06-16","2021-09-21","2021-05-18","2021-05-18","2021-05-18","2020-05-19","2020-08-25","2020-08-11","2020-08-11","2020-08-11","2021-04-20","2021-06-08","2021-06-08","2021-12-07","2020-11-17","2021-07-20"],"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":[["","93081101","NORTRIPTYLINE","HCL25MGCAP","30","Select","Select",""],["","65862039010","ONDANSETRON","ODT4MGTABLET","12","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","60","Select","Select",""],["","70710114003","FLUCONAZOLE","200MGTABLET","14","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","143122701","DICYCLOMINE","20MGTABLET","60","Select","Select",""],["","71093014005","METHOCARBAMOL","500MGTABLET","20","Select","Select",""],["","228202950","ALPRAZOLAM","0.5MGTABLET","10","Select","Select",""],["","245531911","KLOR-CON","M20TABLET","2","Select","Select",""],["","65162074510","PROMETHAZINE","12.5MGTABLET","15","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","20","Select","Select",""],["","69097081312","GABAPENTIN","100MGCAPSULE","90","Select","Select",""],["","43199001101","HYOSCYAMINE","0.125MGTABSL","180","Select","Select",""],["","65162047810","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","172392670","DIAZEPAM","5MGTABLET","2","Select","Select",""],["","43386035701","HYDROCODONE-ACETAMIN","7.5-325","10","Select","Select",""],["","185094098","CHOLESTYRAMINE","PACKET","15","Select","Select",""],["","71930005552","ACETAMINOPHEN-COD","#3TABLET","30","Select","Select",""],["","49483060450","IBUPROFEN","800MGTABLET","24","Select","Select",""],["","31722070530","VALACYCLOVIR","HCL1GRAMTABLET","21","Select","Select",""],["","65862007601","CIPROFLOXACIN","HCL250MGTAB","14","Select","Select",""],["","69097015907","MELOXICAM","15MGTABLET","30","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":""}]}]}