{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOEL R ERVIN","gend":0,"add":"97 Nugget Dr","city":"Dawsonville","state":"GA","zip":30534,"dob":"1962-11-24","age":"","mstatus":"","insh":4252900001,"cliId":"","pno":4042717417,"cno":"","email":"dlervin31@hotmail.com","ename":"","eno":"","pphy":"Ramzi Ghosn","ppno":"","pcpadd":"73 Prestige Lane Ste 103","pcpcity":"Dawsonville","pcpstate":"GA","pcpzip":"","pcpcounty":"Dawsonville","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":["E11.22","I10","E78.2","D51.8","E55.9","E29.1","J01.01","R05.1","H69.83","K76.0","M10.00","G47.33","N18.6","M79.672","M76.822","M21.6X9","I87.2","M10.9","E78.1","F41.1","G47.00","L91.8","J32.8","J44.9","J41.0","J30.9","Z12.2","Z87.891","E66.01","R22.43","I87.303","J30.1","J30.2","N23","Z79.899","G63","K82.4","G47.09","N18.2","R19.7","L02.416","Z71.41","F17.210","Z00.00","Z68.41","Z13.31","L21.9","L82.1","D18.01","L82.0","M25.571","M76.71","Z20.828","E11.9","E79.0","D72.829","I73.9","L73.8","M79.2","M10.071","M65.879","R79.9"],"date":["2021-11-09","2021-11-09","2021-11-09","2021-02-16","2021-02-16","2021-11-09","2021-12-28","2021-12-28","2021-12-28","2021-02-16","2021-09-14","2021-09-14","2021-09-14","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2021-11-09","2021-03-09","2021-02-09","2021-11-09","2021-01-26","2021-12-28","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-03-09","2021-01-19","2020-11-10","2020-04-14","2020-04-14","2021-11-02","2021-05-18","2021-05-18","2021-01-19","2021-07-06","2021-11-09","2021-11-09","2021-04-27","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2020-07-07","2021-07-13","2020-07-07","2020-07-07","2021-03-09","2021-03-09","2021-11-09","2021-03-09","2021-02-09","2021-02-09","2021-03-09","2021-07-13","2021-01-26","2021-07-20","2021-07-20","2021-07-20"],"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":[["","143965901","TESTOSTERONE","CYP200MG\/ML","2","Select","Select",""],["","16571020106","DICLOFENAC","SODEC75MGTAB","60","Select","Select",""],["","45802046564","KETOCONAZOLE","0.02SHAMPOO","120","Select","Select",""],["","55111046605","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","68180072003","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","52937000120","VASCEPA","1GMCAPSULE","120","Select","Select",""],["","68462040601","INDOMETHACIN","25MGCAPSULE","30","Select","Select",""],["","55111072910","ALLOPURINOL","100MGTABLET","30","Select","Select",""],["","68382013610","LOSARTAN","POTASSIUM50MGTAB","30","Select","Select",""],["","70710128403","FLUOCINONIDE","0.0005SOLUTION","60","Select","Select",""],["","168020360","CLINDAMYCIN","PHOSP0.01LOTION","60","Select","Select",""],["","31722093612","OMEGA-3","ETHYLESTERS1GMCAP","120","Select","Select",""],["","67877049005","EZETIMIBE","10MGTABLET","30","Select","Select",""],["","527293441","PREDNISONE","20MGTABLET","10","Select","Select",""],["","254200801","COLCHICINE","0.6MGTABLET","30","Select","Select",""],["","55111061701","ESZOPICLONE","3MGTABLET","30","Select","Select",""],["","67877041401","METFORMIN","HCLER750MGTABLET","30","Select","Select",""],["","29300012410","MELOXICAM","7.5MGTABLET","30","Select","Select",""],["","43547043109","FENOFIBRATE","145MGTABLET","30","Select","Select",""],["","43598026704","ICOSAPENT","ETHYL1GRAMCAPSULE","120","Select","Select",""],["","70377000911","ROSUVASTATIN","CALCIUM40MGTAB","30","Select","Select",""],["","68180051703","LISINOPRIL","40MGTABLET","30","Select","Select",""],["","68462051339","DESONIDE","0.0005LOTION","59","Select","Select",""],["","70710122600","AMITRIPTYLINE","HCL25MGTAB","30","Select","Select",""],["","60505009400","DOXAZOSIN","MESYLATE2MGTAB","30","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","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":""}]}]}