{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stephen K Fraser","gend":0,"add":"2580 Bethesda Church Rd","city":"Carrollton","state":"GA","zip":30117,"dob":"1965-08-22","age":"","mstatus":"","insh":4225500001,"cliId":"","pno":7705844963,"cno":"","email":"stephenkyle@bellsouth.net","ename":"","eno":"","pphy":"RAJESH MATHEW","ppno":"","pcpadd":"8954 Hospital Drive,N","pcpcity":"Douglasville","pcpstate":"GA","pcpzip":"","pcpcounty":"Douglasville","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":["I42.8","I50.22","L97.329","E11.40","E11.65","E11.649","E78.5","I11.0","I25.10","I83.023","Z23","Z86.16","Z79.82","Z79.4","Z79.899","G47.33","Z87.891","M72.2","R06.02","I12.9","N18.9","78900","K21.9","Z20.822","M79.672","F17.210","E66.8","I10","Z68.30","E78.2","I50.43","N17.9","J44.1","I24.8","E11.22","J44.9","E86.0","E83.52","N18.30","E87.5","I87.2","E11.52","E11.621","E11.42","L97.322","Z48.89","I87.331","L97.222","T81.89X","L97.514","E11.622","S80.211","S80.212","Z68.31","L97.302","I50.9","R11.2","E11.9","Z79.84","I50.23","R07.9","I49.5","S91.002","S91.301","G62.9","M79.10","M79.605","M79.604","Z98.890","G47.00","E66.9","M79.671","L97.829","N28.9","R77.8","M79.89","I96","I21.4","B35.1","Z89.429","R79.89","I42.9","G89.29","M79.661","M79.662","I25.119","U07.1","K82.8","S81.802","L53.9","R93.1","I77.810","I34.0","R60.9","I13.0","I50.20","N18.2","Z72.0","Z99.2","M86.171","I25.5","R06.09","Z03.89","L03.115","L97.512","J45.40","J12.82","I50.42","I34.1","I36.1","I27.20","I37.1","L97.309","L97.909","Z68.29","I42.0"],"date":["2021-11-23","2021-10-06","2021-08-10","2021-08-10","2021-11-18","2021-03-09","2021-03-09","2021-10-13","2021-12-28","2021-05-04","2021-03-09","2021-09-22","2021-12-28","2021-12-28","2021-12-28","2021-06-22","2021-12-28","2021-07-27","2021-09-22","2021-07-27","2021-09-22","2021-07-27","2021-12-28","2021-12-28","2021-11-18","2021-11-18","2021-11-18","2021-11-23","2021-11-23","2021-08-10","2021-07-13","2021-06-22","2021-05-11","2021-05-11","2021-09-22","2021-09-22","2021-05-25","2021-05-25","2021-05-11","2021-05-11","2021-09-28","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-10-20","2021-10-20","2021-08-10","2021-10-20","2021-09-22","2021-08-10","2021-08-10","2021-11-18","2021-04-13","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-10-13","2021-10-13","2021-10-13","2021-07-13","2021-07-13","2021-07-13","2021-09-22","2021-07-20","2021-07-20","2021-04-06","2021-09-22","2021-09-22","2021-09-22","2021-04-27","2021-05-11","2021-05-11","2021-09-22","2021-07-13","2021-05-25","2021-05-11","2021-09-22","2021-09-22","2021-05-11","2021-11-18","2021-08-10","2021-08-10","2021-05-11","2021-03-30","2021-09-22","2021-04-06","2021-04-06","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-03-23","2021-06-29","2021-09-22","2021-09-22","2021-03-30","2021-06-22","2021-02-02","2021-02-02","2021-06-01","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-04-13","2021-09-22","2021-06-01","2021-02-23"],"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":[["","68382066001","SPIRONOLACTONE","25MGTABLET","30","Select","Select",""],["","49483060650","GABAPENTIN","300MGCAPSULE","60","Select","Select",""],["","65862019201","FLUOXETINE","HCL10MGCAPSULE","30","Select","Select",""],["","69543013611","TRAMADOL","HCL50MGTABLET","15","Select","Select",""],["","68001015203","CARVEDILOL","25MGTABLET","60","Select","Select",""],["","43547040310","FUROSEMIDE","80MGTABLET","30","Select","Select",""],["","23155051901","ISOSORBIDE","MONONITER30MGTB","60","Select","Select",""],["","31722095105","OXYCODONE-ACETAMINOPHEN","10-325","15","Select","Select",""],["","23155000301","HYDRALAZINE","50MGTABLET","90","Select","Select",""],["","62037099901","POTASSIUM","CLER20MEQTABLET","60","Select","Select",""],["","62332012390","PREGABALIN","150MGCAPSULE","60","Select","Select",""],["","78069620","ENTRESTO","97MG-103MGTABLET","60","Select","Select",""],["","65862056099","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","88221905","LANTUS","SOLOSTAR100UNIT\/ML","15","Select","Select",""],["","49483062081","METFORMIN","HCL1000MGTABLET","30","Select","Select",""],["","50484001030","SANTYL","OINTMENT","30","Select","Select",""],["","487020160","IPRAT-ALBUT","0.5-3(2.5)MG\/3ML","360","Select","Select",""],["","59762040105","SUCRALFATE","1GMTABLET","28","Select","Select",""],["","43598044828","NICOTINE","21MG\/24HRPATCH","28","Select","Select",""],["","27808003703","HYDROCODONE-ACETAMIN","10-325MG","15","Select","Select",""],["","42571016242","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","58160082311","SHINGRIX","VIALKIT","1","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","31722053101","TORSEMIDE","20MGTABLET","30","Select","Select",""],["","58160084252","BOOSTRIX","TDAPVACCINESYRINGE","0.5","Select","Select",""],["","31722072320","LEVOFLOXACIN","750MGTABLET","10","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}