{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lisa A Setzer","gend":1,"add":"133 Azelia Dr","city":"Alto","state":"GA","zip":30510,"dob":"1969-06-23","age":"","mstatus":"","insh":4288080001,"cliId":"","pno":7069499131,"cno":"","email":"lsetzer3@gmail.com","ename":"","eno":"","pphy":"James Jackson","ppno":"","pcpadd":"1515 River Place,Suite 20","pcpcity":"Braselton","pcpstate":"GA","pcpzip":"","pcpcounty":"Braselton","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":["J96.01","J96.02","R19.7","R53.1","R55","R09.02","J81.0","I21.A1","I50.33","Z68.41","D51.3","E66.01","J84.10","U09.9","F41.9","R00.0","F32.A","Z79.899","Z79.82","Z82.49","U07.1","J12.82","J18.9","R77.8","E86.0","R11.2","Z88.1","A09","R50.9","R42","R10.13","Z88.8","R39.9","R91.8","J96.90","R06.00","J84.9","R59.0","J96.11","R06.02","M72.2","M79.672","M77.52","R40.236","R40.214","R40.225","D51.9","Z86.16","E66.9","Z99.81","G43.909","E53.8","Z79.51","Z87.01","Z68.34","Z91.81","G93.3","Z00.00","F33.1","Z13.820","Z12.31","G43.009","R31.9","Z99.89","R79.89","E78.00","F32.9","E87.5","R10.9","R07.81","R74.01","F41.0","Z71.3","Z91.19","J81.1","G43.809","R06.83","E78.5","R05.9","Z87.09","M54.5","M62.830","I36.1","R11.0","R60.9","E66.8","J43.8","M77.32","R53.81","R63.8","M85.852","Z79.1","Z78.0","R07.9","G47.33","Z68.39"],"date":["2021-11-23","2021-11-23","2021-09-22","2021-11-09","2021-09-01","2021-10-20","2021-11-23","2021-11-23","2021-11-23","2021-12-28","2021-11-23","2021-12-28","2021-11-23","2021-12-28","2021-12-28","2021-11-30","2021-12-28","2021-11-23","2021-12-28","2021-11-23","2021-12-28","2021-11-23","2021-11-09","2021-11-09","2021-09-07","2020-07-21","2020-06-23","2021-09-07","2021-09-22","2021-09-07","2021-09-07","2021-09-07","2020-04-09","2021-12-28","2021-10-20","2021-11-18","2021-11-18","2021-10-26","2021-12-28","2021-12-28","2021-12-28","2020-06-30","2020-08-11","2020-07-21","2020-07-21","2020-07-21","2020-02-04","2022-01-04","2021-11-30","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2020-09-08","2020-09-08","2020-09-22","2020-09-22","2020-09-08","2020-09-08","2021-10-26","2021-11-23","2020-11-03","2021-11-09","2021-10-26","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-11-30","2020-07-28","2021-12-28","2021-11-09","2021-12-28","2021-12-28","2020-02-18","2020-03-10","2021-11-09","2021-10-20","2021-11-09","2021-11-09","2021-11-09","2020-07-21","2021-11-09","2021-11-09","2020-09-22","2021-11-09","2020-09-22","2021-10-26","2021-12-28","2021-11-09"],"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":[["","185012201","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","143962125","CYANOCOBALAMIN","1000MCG\/ML","4","Select","Select",""],["","16714079801","SUMATRIPTAN","SUCC100MGTABLET","9","Select","Select",""],["","16714073301","CELECOXIB","200MGCAPSULE","60","Select","Select",""],["","16714061201","SERTRALINE","HCL50MGTABLET","30","Select","Select",""],["","16729028617","ROSUVASTATIN","CALCIUM20MGTAB","30","Select","Select",""],["","59762219803","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","68462030201","INDOMETHACIN","50MGCAPSULE","90","Select","Select",""],["","59746017310","PREDNISONE","10MGTABLET","38","Select","Select",""],["","16714001930","BUDESONIDE","0.5MG\/2MLSUSP","120","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","43547040011","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","10702000301","PROMETHAZINE","25MGTABLET","12","Select","Select",""],["","10702025301","BUTALB-ACETAMIN-CAFF","50-325-40","60","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","65862018730","ONDANSETRON","HCL4MGTABLET","10","Select","Select",""],["","54418625","DEXAMETHASONE","6MGTABLET","5","Select","Select",""],["","378967193","IPRAT-ALBUT","0.5-3(2.5)MG\/3ML","90","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":""}]}]}