{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rita D Butcher","gend":1,"add":"3537 Hwy 76 W","city":"Clayton","state":"GA","zip":30525,"dob":"1967-04-03","age":"","mstatus":"","insh":4225203001,"cliId":"","pno":7069821763,"cno":"","email":"butcher_rita@yahoo.com","ename":"","eno":"","pphy":"EDWARD FREDERICKSON","ppno":"","pcpadd":"156 North Main Street,N","pcpcity":"Clayton","pcpstate":"GA","pcpzip":"","pcpcounty":"Clayton","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":["E78.5","Z79.899","E55.9","R35.0","C50.312","Z17.1","F17.210","C50.912","G89.3","K21.9","K59.00","Z72.0","R11.0","M25.512","M25.612","M62.412","R59.0","Z85.3","G62.9","Z98.890","Z92.3","Z88.2","C50.919","D70.9","M89.9","D75.9","D72.819","D64.9","D69.6","R53.83","E87.6","R30.9","G60.9","G89.29","M54.2","M25.511","Z13.31","C77.0","F33.0","Z78.0","Z68.26","Z79.891","N63.20","Z68.28","R60.9","R05","R06.02","R55","C50.812","J32.9","R51","R09.81","R50.9","H92.02","R11.14","H66.93","R05.8","E04.1","C50.112","R50.81","J01.01","Z51.11","J98.11","I34.0","E07.89","J20.9","M54.5","F41.9","Z76.0","E66.3","Z68.30","Z71.3","Z80.0","Z80.8","Z80.1","Z20.828","R94.31","R63.8","M47.816","M51.9","G47.09","Z68.27","F43.23","Z13.89","C50.911","M54.12","M89.8X9","F10.10","Z51.5","L58.9","K04.7","C77.3","Z71.6","N63.23","C76.0","C50.512","F17.200","K63.5","Z12.11","E53.8","R21","K57.30","R91.8","M79.89","K12.1","Z53.8","R92.8","R22.43","Z91.89","Z01.810","R60.0","I95.1","K59.03","J01.80","R92.2","N64.89","M85.852","Z68.25","J44.9","Z98.891","H53.8"],"date":["2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-09-01","2021-09-01","2020-12-08","2021-08-24","2021-10-13","2020-08-04","2020-08-04","2021-03-30","2021-08-05","2021-12-28","2021-12-07","2021-12-07","2021-04-20","2021-12-28","2021-03-30","2021-08-24","2021-03-30","2021-03-30","2021-12-28","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2021-07-27","2021-10-13","2021-12-28","2021-01-26","2021-01-26","2020-03-10","2020-11-10","2020-03-10","2021-08-10","2020-03-10","2021-11-09","2020-03-31","2020-03-03","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-09-29","2020-04-28","2020-04-28","2020-04-28","2020-05-26","2020-04-28","2021-12-08","2021-12-08","2021-12-08","2021-02-23","2021-11-09","2020-05-26","2021-09-22","2020-06-30","2020-09-22","2020-09-22","2020-02-04","2020-09-22","2021-07-13","2021-12-28","2020-03-24","2020-09-22","2020-12-01","2020-09-22","2021-09-28","2020-03-17","2020-08-25","2020-10-06","2020-03-10","2020-03-10","2020-09-01","2020-08-25","2020-02-25","2021-09-28","2020-02-25","2020-03-03","2020-09-29","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2021-01-06","2020-12-29","2020-06-09","2020-09-22","2020-02-11","2020-06-30","2020-11-10","2021-01-06","2021-12-14","2021-11-30","2021-12-28","2020-02-04","2021-12-14","2020-03-31","2020-03-31","2020-08-25","2021-12-07","2020-09-29","2020-09-15","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2020-03-03","2020-03-03","2020-02-18","2020-02-18","2021-08-17","2020-01-07","2020-01-07","2020-09-29","2021-08-05"],"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":[["","65862019405","FLUOXETINE","HCL40MGCAPSULE","30","Select","Select",""],["","68382080610","TRAZODONE","100MGTABLET","60","Select","Select",""],["","65162046650","IBUPROFEN","800MGTABLET","30","Select","Select",""],["","67877025145","TRIAMCINOLONE","0.001CREAM","454","Select","Select",""],["","406012405","HYDROCODONE-ACETAMIN","7.5-325","90","Select","Select",""],["","121081016","NYSTATIN","100000UNIT\/MLSUSP","120","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","6","Select","Select",""],["","16714044901","AMITRIPTYLINE","HCL75MGTAB","30","Select","Select",""],["","59746011506","PROCHLORPERAZINE","10MGTAB","60","Select","Select",""],["","49884005601","IMIPRAMINE","HCL50MGTABLET","30","Select","Select",""],["","53746020401","OXYCODONE-ACETAMINOPHEN","10-325","60","Select","Select",""],["","67877014601","TEMAZEPAM","15MGCAPSULE","30","Select","Select",""],["","64380073706","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","10702000310","PROMETHAZINE","25MGTABLET","30","Select","Select",""],["","62175061746","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","4110150","XELODA","500MGTABLET","84","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","68382009205","CARVEDILOL","3.125MGTABLET","60","Select","Select",""],["","50383066730","LIDOCAINE-PRILOCAINE","CREAM","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MGTABLET","3","Select","Select",""],["","832532515","POTASSIUM","CLER20MEQTABLET","30","Select","Select",""],["","16729007329","CAPECITABINE","500MGTABLET","84","Select","Select",""],["","65862018830","ONDANSETRON","HCL8MGTABLET","6","Select","Select",""],["","59762219803","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","42858010350","OXYCODONE-ACETAMINOPHN","7.5-325","15","Select","Select",""],["","43547040111","FUROSEMIDE","20MGTABLET","30","Select","Select",""],["","69680011225","CYANOCOBALAMIN","1000MCG\/ML","1","Select","Select",""],["","58657067650","CIPROFLOXACIN","HCL500MGTAB","20","Select","Select",""],["","50383077504","LIDOCAINE","0.02VISCOUSSOLN","120","Select","Select",""],["","69029210","NIVESTYM","480MCG\/0.8MLSYRING","4","Select","Select",""],["","43547035211","LISINOPRIL","5MGTABLET","30","Select","Select",""],["","16714073201","CELECOXIB","100MGCAPSULE","60","Select","Select",""],["","52817033050","CYCLOBENZAPRINE","5MGTABLET","45","Select","Select",""],["","406048410","ACETAMINOPHEN-COD","#3TABLET","28","Select","Select",""],["","10572010101","PEG-3350","ANDELECTROLYTESSOLN","4000","Select","Select",""],["","68001036206","CEFDINIR","300MGCAPSULE","14","Select","Select",""],["","16714029904","AMOXICILLIN","500MGCAPSULE","30","Select","Select",""],["","42858000101","OXYCODONE","HCL5MGTABLET","20","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":""}]}]}