{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Madisen T Clines","gend":1,"add":"40 Summit Dr SE","city":"Lindale","state":"GA","zip":30147,"dob":"2001-01-10","age":"","mstatus":"","insh":4350428001,"cliId":"","pno":7066763393,"cno":"","email":"madisen.clines@gmail.com","ename":"","eno":"","pphy":"JOHN JOYAVE","ppno":"","pcpadd":"7311 Fairmount Hwy SE","pcpcity":"Calhoun","pcpstate":"GA","pcpzip":"","pcpcounty":"Calhoun","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":["M25.511","Z68.51","R10.9","R11.0","R10.819","G89.4","M54.5","M54.2","M79.18","R00.0","G44.209","G95.0","M79.7","A04.8","Z15.89","Z31.430","F90.2","G47.00","F32.0","E03.9","F41.9","F43.10","Z79.899","D51.8","Z30.09","Z68.24","Z01.89","F43.25","R25.2","Z00.00","Z13.31","Z60.2","Z80.49","Z79.891","Z79.890","R51","H93.11","M35.3","G43.909","N92.6","N20.0","Z00.01","Z13.9","F90.0","G43.709","F33.41","Z13.220","B35.1","Z68.52","M54.6","R53.83","M47.817","Z30.017","Z30.40","Z30.9","Z30.8","M46.06","Z72.51","Z68.22","R20.2","G56.01","Z20.822","Z30.42","M79.10","M54.50","N39.0","Z30.46"],"date":["2021-12-28","2020-01-28","2021-01-19","2021-09-02","2020-12-15","2021-12-28","2021-11-09","2021-12-28","2021-12-28","2020-10-06","2021-11-30","2021-04-20","2021-04-20","2021-11-09","2020-12-22","2020-12-22","2020-12-29","2020-10-20","2020-09-29","2021-11-30","2020-08-04","2020-10-20","2021-12-28","2020-03-12","2020-09-15","2020-08-18","2020-06-02","2022-01-06","2020-03-17","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2020-04-09","2020-09-29","2021-07-06","2021-01-19","2021-03-16","2021-03-16","2021-12-28","2021-11-23","2021-12-28","2021-03-16","2020-08-25","2021-12-28","2021-12-28","2021-11-30","2020-10-13","2020-09-29","2020-09-29","2020-09-29","2020-08-25","2020-10-06","2020-10-20","2020-10-06","2021-07-20","2021-11-30","2021-08-31","2020-01-22","2020-01-07","2021-12-28","2020-12-22","2020-10-13"],"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":[["","69238131709","PREGABALIN","300MGCAPSULE","60","Select","Select",""],["","69097084507","CYCLOBENZAPRINE","5MGTABLET","60","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","30","Select","Select",""],["","13668013701","ESCITALOPRAM","20MGTABLET","30","Select","Select",""],["","70954002010","PRAZOSIN","2MGCAPSULE","30","Select","Select",""],["","13811070910","METHYLPHENIDATE","ER54MGTAB","30","Select","Select",""],["","53489011905","DOXYCYCLINE","HYCLATE100MGCAP","14","Select","Select",""],["","65162019050","NAPROXEN","500MGTABLET","14","Select","Select",""],["","65862039010","ONDANSETRON","ODT4MGTABLET","24","Select","Select",""],["","378180310","LEVOTHYROXINE","50MCGTABLET","30","Select","Select",""],["","70710122600","AMITRIPTYLINE","HCL25MGTAB","30","Select","Select",""],["","51991036378","RIZATRIPTAN","10MGODT","12","Select","Select",""],["","50111043401","TRAZODONE","100MGTABLET","30","Select","Select",""],["","574220120","TRETINOIN","0.001CREAM","20","Select","Select",""],["","47781030301","NITROFURANTOIN","MONO-MCR100MG","10","Select","Select",""],["","115166003","PROPRANOLOL","20MGTABLET","60","Select","Select",""],["","43386048024","ORPHENADRINE","ER100MGTABLET","60","Select","Select",""],["","51991083801","CYPROHEPTADINE","4MGTABLET","30","Select","Select",""],["","50111033301","METRONIDAZOLE","250MGTABLET","56","Select","Select",""],["","555902658","JUNEL","FE1MG-20MCGTABLET","28","Select","Select",""],["","52433001","NEXPLANON","68MGIMPLANT","1","Select","Select",""],["","60505393001","GUANFACINE","HCLER4MGTABLET","30","Select","Select",""],["","71093014005","METHOCARBAMOL","500MGTABLET","30","Select","Select",""],["","65162052110","PROMETHAZINE","25MGTABLET","40","Select","Select",""],["","16729020001","BUSPIRONE","HCL5MGTABLET","60","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":""}]}]}