{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Amy Kennedy","gend":1,"add":"15 Clark Ave NW","city":"Rome","state":"GA","zip":30165,"dob":"1977-04-11","age":"","mstatus":"","insh":4330152001,"cliId":"","pno":2194874039,"cno":"","email":"amypk1977@gmail.com","ename":"","eno":"","pphy":"James Douglas","ppno":"","pcpadd":"15 Riverbend Drive SW Ste 200","pcpcity":"Rome","pcpstate":"GA","pcpzip":"","pcpcounty":"Rome","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"APT 5","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":["D89.89","F15.129","F32.9","F41.9","N32.81","E11.65","R79.89","Z79.82","Z79.4","E10.65","E16.1","Z79.899","Z11.3","Z01.419","R87.612","N93.9","R10.32","R11.0","E11.9","R30.0","Z32.02","N39.0","N92.6","Z11.51","D25.9","R76.8","N93.8","R10.2","Z00.00","Z80.3","Z80.0","E10.9","E78.2","M79.602","M79.601","Z12.31","Z20.2","Z68.23","M25.551","M25.552","M25.561","S93.601","G89.11","R87.810","N87.0","M54.2","M25.562","Z23","F41.1","Z87.42","E10.22","N18.1","I21.4","R09.81","R43.0","H92.09","R05","R07.1","Z79.84","M25.511","M25.512","N30.00","R07.89","M25.50","R53.83","E55.9","M79.10","Z20.828","J20.8","H65.06","R00.0","R94.31","F15.10","R76.0","K92.1","N76.0","M79.671","R55","R51","H53.8","H61.22","J06.9"],"date":["2021-07-27","2021-02-02","2021-02-02","2021-02-02","2021-03-09","2021-02-02","2021-08-17","2021-08-17","2021-11-23","2021-11-23","2021-11-23","2021-12-28","2021-12-28","2021-10-06","2020-06-09","2021-08-17","2021-09-14","2021-08-17","2021-08-17","2021-12-28","2021-11-16","2020-06-23","2020-06-09","2021-10-05","2021-09-14","2021-12-16","2021-01-26","2021-08-17","2021-01-26","2020-11-10","2021-12-16","2021-07-06","2020-06-23","2021-06-08","2021-06-08","2020-05-19","2020-05-19","2020-05-19","2021-12-16","2021-12-16","2021-12-16","2020-05-05","2020-05-05","2021-11-16","2020-08-04","2021-12-16","2021-12-16","2020-11-10","2021-03-09","2020-11-10","2020-11-10","2020-11-10","2020-06-09","2020-08-11","2020-08-11","2020-08-11","2020-09-22","2020-08-11","2020-08-11","2021-12-16","2021-12-16","2021-08-31","2020-03-24","2021-07-13","2021-07-13","2021-08-04","2021-07-13","2020-08-18","2020-08-04","2020-09-29","2020-03-31","2020-03-31","2020-06-09","2021-12-16","2021-12-16","2021-09-28","2020-06-09","2020-04-09","2020-03-03","2021-07-06","2020-09-29","2020-08-18"],"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":[["","16729013716","CLONAZEPAM","1MGTABLET","60","Select","Select",""],["","169633910","NOVOLOG","100UNIT\/MLFLEXPEN","30","Select","Select",""],["","378718505","METFORMIN","HCL500MGTABLET","60","Select","Select",""],["","65862001305","SERTRALINE","HCL100MGTABLET","30","Select","Select",""],["","57237000511","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","88221905","LANTUS","SOLOSTAR100UNIT\/ML","3","Select","Select",""],["","8290320119","BD","UFMINIPENNEEDLE5MMX31G","100","Select","Select",""],["","55111012305","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","13811071910","NITROFURANTOIN","MONO-MCR100MG","14","Select","Select",""],["","781808926","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","51293081101","PHENAZOPYRIDINE","200MGTAB","6","Select","Select",""],["","93005401","BUSPIRONE","HCL10MGTABLET","90","Select","Select",""],["","60505470303","SOLIFENACIN","10MGTABLET","30","Select","Select",""],["","29300012410","MELOXICAM","7.5MGTABLET","30","Select","Select",""],["","45802071708","TERCONAZOLE","80MGSUPPOSITORY","3","Select","Select",""],["","55111012701","CIPROFLOXACIN","HCL500MGTAB","6","Select","Select",""],["","52817033200","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","378001805","METOPROLOL","TARTRATE25MGTAB","30","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","10","Select","Select",""],["","69918030130","TRANEXAMIC","ACID650MGTABLET","30","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","55111018015","TIZANIDINE","HCL4MGTABLET","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":""}]}]}