{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHY R CLARK","gend":1,"add":"33 Anchor Dr","city":"Rossville","state":"GA","zip":30741,"dob":"1958-06-12","age":"","mstatus":"","insh":4178158001,"cliId":"","pno":4234132742,"cno":"","email":"reneeclarkdale@gmail.com","ename":"","eno":"","pphy":"Phillip Andrews","ppno":"","pcpadd":"3891 Adkisson Dr","pcpcity":"Cleveland","pcpstate":"TN","pcpzip":"","pcpcounty":"Cleveland","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":["Z00.00","G47.33","R07.0","J32.9","M25.572","M47.816","M25.571","M50.321","M50.322","M50.323","M54.12","L71.9","L82.1","L81.4","D48.5","R10.9","C50.919","K52.9","E11.9","I10","E78.00","R00.2","G62.9","E78.5","E55.9","R25.2","Z13.89","Z68.38","G25.81","K21.9","E11.40","Z73.3","E86.0","C77.3","M54.16","G90.09","Z91.040","E11.65","M54.5","M54.2","R53.1","E66.9","Z68.39","Z79.899","E11.49","M72.2","I82.609","R26.9","M51.36","M47.896","Z79.891","H35.313","H02.831","H02.834","M51.26","M51.27","M48.07","L01.00","D22.5","L85.3","L57.0","Z68.37","Z90.49","Z85.3","Z90.710","Z79.84","Z87.891","Z90.10","Z82.49","Z80.8","Z83.3","Z82.3","H26.9","G47.30","C50.612","H25.13","N39.0","N90.89","K64.4","R13.10","K57.90","N30.00","R10.32","G57.93","M47.26","Z01.419","Z11.51","Z20.828","Z80.9","Z80.6","K57.92","Z88.1","Z88.8","C50.912","M79.662","K57.30","H35.321","M48.061","M51.17","S19.9XX","M50.30","M47.12","G89.29","B37.2","L82.0","L29.2","M54.50","I82.409","Z79.4","Z11.1","S09.90X","M79.89","M79.601","R92.8","M79.18"],"date":["2021-06-01","2021-12-28","2020-02-04","2020-02-04","2021-12-07","2021-12-28","2021-12-07","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-06-01","2021-06-01","2021-06-01","2021-12-14","2021-11-16","2021-06-01","2021-06-01","2021-11-16","2020-11-03","2020-11-03","2020-08-04","2020-08-04","2020-11-03","2020-11-03","2021-11-23","2020-11-03","2020-11-03","2020-08-04","2020-08-25","2020-11-17","2020-12-08","2020-12-08","2021-12-14","2020-11-17","2021-12-21","2020-06-30","2020-09-15","2020-06-30","2020-09-15","2021-01-19","2021-10-19","2020-06-30","2020-05-19","2020-10-13","2020-10-13","2020-10-13","2021-05-18","2021-01-26","2021-01-26","2021-11-23","2021-11-23","2021-11-23","2020-11-24","2021-08-04","2021-08-04","2021-11-23","2020-05-26","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-03-17","2020-09-15","2020-03-17","2020-09-15","2020-09-15","2020-12-15","2020-12-15","2021-08-31","2021-05-18","2021-12-28","2021-11-16","2021-11-16","2021-12-07","2021-10-26","2021-10-26","2021-10-26","2021-11-30","2021-12-28","2021-12-28","2021-12-28","2020-09-15","2020-09-15","2020-09-15","2021-10-05","2021-10-05","2021-10-05","2021-11-09","2021-10-19","2021-10-13","2021-12-14","2021-11-16","2021-11-16","2021-11-30","2021-12-21","2021-12-21","2020-11-03","2020-11-03","2021-04-13","2021-12-28","2021-12-07","2021-11-09","2021-08-17","2021-05-11","2021-11-30","2021-11-09","2020-06-09","2021-07-27","2020-11-17"],"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":[["","27241011703","FENOFIBRATE","160MGTABLET","30","Select","Select",""],["","43547035411","LISINOPRIL","20MGTABLET","30","Select","Select",""],["","55111032101","GLIMEPIRIDE","2MGTABLET","60","Select","Select",""],["","57664037708","TRAMADOL","HCL50MGTABLET","60","Select","Select",""],["","16714066301","GABAPENTIN","400MGCAPSULE","90","Select","Select",""],["","68462018022","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","16714098901","ROSUVASTATIN","CALCIUM10MGTAB","30","Select","Select",""],["","70010006501","METFORMIN","HCL1000MGTABLET","60","Select","Select",""],["","169430713","RYBELSUS","7MGTABLET","30","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","168032346","METRONIDAZOLE","0.0075CREAM","45","Select","Select",""],["","8627005303","DEXCOM","G6SENSOR","3","Select","Select",""],["","66869040490","LIVALO","4MGTABLET","30","Select","Select",""],["","57237009960","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","68462025301","ROPINIROLE","HCL0.25MGTABLET","30","Select","Select",""],["","58160088552","FLUARIX","QUAD2020-2021SYRINGE","0.5","Select","Select",""],["","17478007035","ERYTHROMYCIN","0.005EYEOINTMENT","3.5","Select","Select",""],["","47781030301","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","55111018015","TIZANIDINE","HCL4MGTABLET","90","Select","Select",""],["","65862018601","CLINDAMYCIN","HCL300MGCAPSULE","30","Select","Select",""],["","2871501","HUMULIN","70-30VIAL","10","Select","Select",""],["","80777027310","MODERNA","COVID-19VACCINE(EUA)","0.2","Select","Select",""],["","51224002218","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","69238110002","DOXYCYCLINE","HYCLATE100MGCAP","14","Select","Select",""],["","69315031228","PROCTO-MED","HC0.025CREAM","28","Select","Select",""],["","45802005911","NYSTATIN","100000UNIT\/GMCREAM","30","Select","Select",""],["","406048401","ACETAMINOPHEN-COD","#3TABLET","30","Select","Select",""],["","67877021620","CEFUROXIME","AXETIL500MGTAB","14","Select","Select",""],["","169413212","OZEMPIC","0.25-0.5MG\/DOSEPEN","1.5","Select","Select",""],["","406012301","HYDROCODONE-ACETAMIN","5-325MG","45","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","56151173301","TRUEPLUS","SYR1ML31GX5\/16","100","Select","Select",""],["","93224001","CEPHALEXIN","500MGTABLET","14","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","21","Select","Select",""],["","68462011944","FLUCONAZOLE","150MGTABLET","2","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":""}]}]}