{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Shirley Cromer","gend":1,"add":"241 Blacks Bluff Rd SW","city":"Rome","state":"GA","zip":30161,"dob":"1958-05-12","age":"","mstatus":"","insh":4310236001,"cliId":"","pno":7706086584,"cno":"","email":"tcromer357@yahoo.com","ename":"","eno":"","pphy":"Devender Reddy","ppno":"","pcpadd":"1010 Johnson Ferry Road,N","pcpcity":"Marietta","pcpstate":"GA","pcpzip":"","pcpcounty":"Marietta","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":["Z79.899","H25.013","H53.2","I49.5","I10","I47.1","R53.1","M62.830","M54.5","N39.0","R53.83","E55.9","E53.8","R74.8","Z20.828","R31.9","R10.2","N20.0","R31.0","M25.50","Z11.59","Z01.419","Z23","E11.9","J45.20","L71.9","R11.0","M19.90","R30.9","A46","M79.7","K22.70","Z87.892","Z12.31","H00.019"],"date":["2021-06-22","2021-05-25","2021-05-25","2021-02-02","2021-06-29","2021-02-02","2021-02-02","2020-06-30","2020-06-30","2022-01-06","2020-11-17","2021-06-29","2021-06-29","2021-06-29","2020-09-29","2022-01-06","2021-12-16","2022-01-06","2022-01-06","2021-06-22","2021-06-22","2021-12-16","2020-11-17","2021-06-29","2020-11-17","2020-11-17","2020-11-17","2021-06-22","2021-05-04","2021-05-04","2021-06-22","2021-06-29","2021-06-29","2021-12-08","2020-12-15"],"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":[["","68382095201","DEXTROAMP-AMPHETAMIN","10MGTAB","60","Select","Select",""],["","59310057922","PROAIR","HFA90MCGINHALER","8.5","Select","Select",""],["","70436001106","BUPROPION","HCLXL300MGTABLET","30","Select","Select",""],["","52817033010","CYCLOBENZAPRINE","5MGTABLET","30","Select","Select",""],["","68180063602","ATORVASTATIN","20MGTABLET","30","Select","Select",""],["","186037020","SYMBICORT","160-4.5MCGINHALER","10.2","Select","Select",""],["","55111046705","METOPROLOL","SUCCER50MGTAB","30","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","70069000510","CYANOCOBALAMIN","1000MCG\/ML","4","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","527551437","DEXTROAMP-AMPHET","ER25MGCAP","30","Select","Select",""],["","51991074790","DULOXETINE","HCLDR30MGCAP","30","Select","Select",""],["","27241005103","ARIPIPRAZOLE","2MGTABLET","30","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MGAUTO-INJECT","2","Select","Select",""],["","51991070505","ALPRAZOLAM","0.5MGTABLET","90","Select","Select",""],["","781214501","AMPICILLIN","500MGCAPSULE","40","Select","Select",""],["","61442010201","DICLOFENAC","SODDR50MGTAB","60","Select","Select",""],["","65862000899","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","59267100003","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","55111012705","CIPROFLOXACIN","HCL500MGTAB","10","Select","Select",""],["","70010077001","METHOCARBAMOL","750MGTABLET","30","Select","Select",""],["","69680013300","POTASSIUM","CLER10MEQTABLET","60","Select","Select",""],["","65862086001","FAMOTIDINE","40MGTABLET","30","Select","Select",""],["","59746001504","METHYLPREDNISOLONE","32MGTAB","2","Select","Select",""],["","62332008090","VALSARTAN-HCTZ","160-12.5MGTAB","30","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":""}]}]}