{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carolyn Howell","gend":1,"add":"292 Mull Rd","city":"Morganton","state":"GA","zip":30560,"dob":"1961-07-13","age":"","mstatus":"","insh":4189127001,"cliId":"","pno":7063746207,"cno":"","email":"carolynandgary21@gmail.com","ename":"","eno":"","pphy":"WILLIAM BREEDLOVE","ppno":"","pcpadd":"162 Hospital Rd,Suite ","pcpcity":"Blairsville","pcpstate":"GA","pcpzip":"","pcpcounty":"Blairsville","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":["I10","F41.9","Z20.828","F17.200","Z79.82","Z82.49","G47.00","M77.9","F17.210","K37","R10.9","R14.3","R06.02","K35.30","G89.4","M54.16","M79.604","F11.20","Z79.891","K35.80","J40","M79.672","J01.90","K35.890","J20.9","R10.31"],"date":["2021-08-17","2021-08-17","2021-08-17","2020-10-27","2020-10-27","2020-10-27","2020-02-25","2020-02-25","2021-04-20","2020-05-12","2020-06-23","2020-06-23","2021-09-28","2020-05-05","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-04-21","2021-08-24","2021-04-20","2021-04-06","2020-05-26","2021-09-28","2020-05-05"],"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":[["","59762372004","ALPRAZOLAM","0.5MGTABLET","90","Select","Select",""],["","93075210","ATENOLOL","50MGTABLET","60","Select","Select",""],["","65862056090","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","43547035611","LISINOPRIL","40MGTABLET","30","Select","Select",""],["","71093015604","ZOLPIDEM","TARTRATE10MGTABLET","30","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","60","Select","Select",""],["","16571020150","DICLOFENAC","SODEC75MGTAB","60","Select","Select",""],["","65862064230","AZITHROMYCIN","500MGTABLET","7","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","10","Select","Select",""],["","27808003502","HYDROCODONE-ACETAMIN","5-325MG","15","Select","Select",""],["","68180096301","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","49281042050","FLUZONE","QUAD2020-2021SYRINGE","0.5","Select","Select",""],["","80777027398","MODERNA","COVID-19VACCINE(EUA)","0.2","Select","Select",""],["","64380080807","IBUPROFEN","600MGTABLET","90","Select","Select",""],["","68382091634","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","70954005820","PREDNISONE","5MGTABLET","7","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":""}]}]}