{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jessica Dlugonski","gend":1,"add":"766 Henry Owen Road SW","city":"Dalton","state":"GA","zip":30720,"dob":"1996-01-27","age":"","mstatus":"","insh":4316126001,"cliId":"","pno":7066719898,"cno":"","email":"jessanne27@yahoo.com","ename":"","eno":"","pphy":"MEGAN BROWN","ppno":"","pcpadd":"800 GI Maddox Pkwy","pcpcity":"Chatsworth","pcpstate":"GA","pcpzip":"","pcpcounty":"Chatsworth","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":["F11.10","F15.10","F90.9","A74.9","E66.01","Z68.41","R00.0","S93.401","S83.411","S52.124","T40.1X1","S82.64X","Z20.2","F90.0","Z79.891","Z01.419","Z13.89","N92.1","L25.9","L30.9","R87.610","R87.810","Z78.9","Z72.0","M79.641","T40.601","Z11.51","M79.643","N63.10","M25.531","F90.2","Z79.899","S52.121","F41.8","S80.01X","M25.521","F41.0","T40.692","M25.571","F11.99","T40.3X4","M25.561"],"date":["2020-12-15","2020-12-15","2021-11-09","2020-12-15","2020-12-15","2020-12-15","2021-10-05","2022-01-06","2020-09-15","2020-10-27","2020-12-15","2021-11-02","2020-10-13","2020-04-09","2020-04-09","2020-11-24","2020-06-23","2020-06-30","2020-06-23","2020-09-15","2020-11-24","2020-11-24","2020-08-25","2020-08-25","2020-11-03","2021-04-27","2020-11-24","2020-11-03","2022-01-06","2020-06-30","2021-04-27","2021-04-27","2020-08-04","2021-11-09","2020-09-15","2020-08-11","2021-11-09","2020-12-22","2021-11-09","2020-12-29","2020-12-15","2020-09-15"],"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":[["","228306011","DEXTROAMP-AMPHET","ER20MGCAP","30","Select","Select",""],["","51862054506","SRONYX","0.10-0.02MGTABLET","28","Select","Select",""],["","67877032105","IBUPROFEN","800MGTABLET","90","Select","Select",""],["","45802006535","TRIAMCINOLONE","0.005CREAM","30","Select","Select",""],["","68462039429","ALYACEN","1278528TABLET","28","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","14","Select","Select",""],["","603533815","PREDNISONE","10MGTABDOSEPACK","21","Select","Select",""],["","57237002801","AMOXICILLIN","500MGTABLET","21","Select","Select",""],["","527150437","DEXTROAMP-AMPHETAMIN","15MGTAB","60","Select","Select",""],["","69097083512","SERTRALINE","HCL100MGTABLET","30","Select","Select",""],["","42806016005","HYDROXYZINE","HCL25MGTABLET","30","Select","Select",""],["","51224012230","AZITHROMYCIN","500MGTABLET","2","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMIN","5-325MG","20","Select","Select",""],["","16571020106","DICLOFENAC","SODEC75MGTAB","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":""}]}]}