{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ginger Sheriff","gend":1,"add":"178 Arrowhead Dr","city":"Lavonia","state":"GA","zip":30553,"dob":"1965-11-28","age":"","mstatus":"","insh":4207317002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"William Mills","ppno":"","pcpadd":"743 Spring Street NE","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":["J02.9","Z03.818","E03.9","K21.00","G47.00","E61.1","E55.9","E53.8","J34.89","R11.0","R05","J45.21","M25.571","M62.81","N95.1","M25.551","Z68.35","J01.00","J40","H65.111","R05.9","Z68.32","E05.90","E03.8","E06.3","Z00.00","E04.1","M25.50","R53.83","R51.9","E23.0","R61","F41.1","F41.0","R44.2","Z00.01","F31.12","Z12.31","R37","J45.20","B00.1","J30.2","E34.9","Z23","Z68.33","F32.9","J02.0","Z20.822","E66.9","M72.2","I73.00","F39","M54.2","G89.29","M79.641","M79.642","M79.671","M79.672","B37.3","R21","Z68.34","L30.1","L84","L85.3","B07.0","R23.8","L72.0","B37.9","J45.990","Z13.220","J01.01","E05.80","D72.820","M06.9","K21.9"],"date":["2021-01-26","2021-01-26","2021-02-02","2021-02-02","2021-11-23","2021-11-02","2021-11-02","2021-11-02","2021-01-26","2021-01-26","2021-03-09","2021-03-09","2021-12-28","2021-12-28","2021-10-19","2021-06-01","2021-09-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-10-20","2021-11-02","2020-04-09","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-02","2021-11-02","2021-11-30","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-10-19","2021-11-02","2021-11-02","2021-01-19","2021-03-02","2021-09-28","2020-02-04","2020-05-19","2021-03-09","2020-02-04","2021-03-09","2021-03-09","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2020-05-19","2020-04-09","2020-09-29","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-01-21","2020-02-18","2020-09-29","2020-09-29","2021-09-28","2020-01-14","2021-03-09","2021-03-09","2021-03-09"],"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":[["","68001025204","FLUCONAZOLE","100MGTABLET","5","Select","Select",""],["","24979002707","DILTIAZEM","24HER(CD)180MGCP","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA90MCGINHALER","18","Select","Select",""],["","69238183301","LEVOTHYROXINE","88MCGTABLET","30","Select","Select",""],["","51862033401","ESTRADIOL","2MGTABLET","30","Select","Select",""],["","68462039710","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","42192033001","NP","THYROID60MGTABLET","30","Select","Select",""],["","378427693","VALACYCLOVIR","HCL1GRAMTABLET","4","Select","Select",""],["","173085910","BREO","ELLIPTA100-25MCGINH","60","Select","Select",""],["","16729044416","BUPROPION","HCLXL300MGTABLET","30","Select","Select",""],["","591024010","LORAZEPAM","0.5MGTABLET","60","Select","Select",""],["","13668001105","CITALOPRAM","HBR40MGTABLET","30","Select","Select",""],["","68462018022","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","70710128500","BACLOFEN","10MGTABLET","90","Select","Select",""],["","456045901","ARMOUR","THYROID60MGTABLET","30","Select","Select",""],["","80777027315","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","68382013814","TOPIRAMATE","25MGTABLET","60","Select","Select",""],["","472015060","NYSTATIN-TRIAMCINOLONE","CREAM","60","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","13668000810","ZOLPIDEM","TARTRATE10MGTABLET","30","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","42","Select","Select",""],["","10702025350","BUTALB-ACETAMIN-CAFF","50-325-40","30","Select","Select",""],["","59746017509","PREDNISONE","20MGTABLET","12","Select","Select",""],["","168005646","BETAMETHASONE","DP0.0005OINT","45","Select","Select",""],["","173068220","VENTOLIN","HFA90MCGINHALER","18","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","120","Select","Select",""],["","66993058497","FLUTICASONE-SALMETEROL","100-50","60","Select","Select",""],["","42571017601","PIROXICAM","10MGCAPSULE","60","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MGTABLET","10","Select","Select",""],["","574402435","ERYTHROMYCIN","0.005EYEOINTMENT","3.5","Select","Select",""],["","45802026937","PERMETHRIN","0.05CREAM","60","Select","Select",""],["","45802005536","TRIAMCINOLONE","0.001OINTMENT","80","Select","Select",""],["","68001036103","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","68001024604","ONDANSETRON","ODT4MGTABLET","15","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":""}]}]}