{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ikea Simmons","gend":0,"add":"105 Wilson St","city":"Gray","state":"GA","zip":31032,"dob":"1978-05-19","age":"","mstatus":"","insh":4371401001,"cliId":"","pno":4783192021,"cno":"","email":"ikeasimmons@live.com","ename":"","eno":"","pphy":"WILLIAM TAUNTON","ppno":"","pcpadd":"120 N Lee St,Suite ","pcpcity":"Forsyth","pcpstate":"GA","pcpzip":"","pcpcounty":"Forsyth","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","N17.1","B20","I16.1","N17.9","R77.8","J96.00","N18.32","E11.22","Z79.4","I12.9","K21.9","J45.909","E78.5","G62.9","M10.9","Z68.41","E66.01","E11.621","E11.610","E11.49","J18.9","J81.1","R78.81","B19.10","K92.0","E87.70","Z99.2","D63.1","Z86.16","Z20.822","Z88.8","B95.7","R06.03","E11.8","Z68.42","M79.641","Z23","Z09","I10","E11.29","E11.65","E11.9","J81.0","R79.89","D64.9","F33.9","N18.4","E87.2","E78.2","M14.679","N18.6","L03.116","I12.0","R65.10","E87.6","E11.51","R09.02","L97.529","G47.30","R06.02","N18.2","R65.11","R05","M79.89","M79.672","J30.9","I51.7","I34.0","I27.20","I36.1","E55.9","E11.69","E78.49","J12.82","G47.33","N18.9","F34.1","E11.40","Z12.5","Z00.00","N18.5","D72.829","E11.44","R07.9","E11.42","Z45.2","R91.8","Z00.01","Z01.89","U07.1","R74.8","I50.9","J98.4","R00.0","I50.1","R50.9"],"date":["2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-10-20","2021-12-21","2021-12-21","2021-12-21","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-12-21","2021-12-28","2021-11-23","2021-12-21","2021-11-23","2021-12-28","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-28","2021-12-28","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-08","2021-05-18","2021-05-18","2021-10-13","2021-10-13","2021-11-18","2021-12-28","2021-11-18","2021-11-23","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-11-30","2021-11-30","2021-10-06","2021-05-18","2021-12-28","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-23","2021-11-18","2021-10-06","2021-11-23","2021-11-23","2021-06-15","2021-11-18","2021-11-18","2021-06-15","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-11-18","2021-09-07","2021-09-07","2021-12-08","2021-08-24","2021-11-23","2021-11-23","2021-04-27","2021-04-27","2021-04-27","2021-12-28","2021-12-28","2021-04-13","2021-10-06","2021-10-06","2021-12-28","2021-12-28","2021-02-23","2021-11-23","2021-02-02","2021-11-23","2021-12-28","2021-11-18","2021-12-21","2021-12-08","2021-11-18"],"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":[["","42571023790","AMLODIPINE-OLMESARTAN","14732MG","30","Select","Select",""],["","55111028050","LEVOFLOXACIN","500MGTABLET","7","Select","Select",""],["","487950125","ALBUTEROL","SUL2.5MG\/3MLSOLN","150","Select","Select",""],["","51672131200","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","43598071901","CHLORTHALIDONE","25MGTABLET","30","Select","Select",""],["","61958210101","ODEFSEY","TABLET","30","Select","Select",""],["","43547040310","FUROSEMIDE","80MGTABLET","30","Select","Select",""],["","23155000301","HYDRALAZINE","50MGTABLET","90","Select","Select",""],["","23155066201","CALCITRIOL","0.25MCGCAPSULE","30","Select","Select",""],["","13668008105","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","50111078766","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","65862016901","ATENOLOL","50MGTABLET","60","Select","Select",""],["","88221905","LANTUS","SOLOSTAR100UNIT\/ML","15","Select","Select",""],["","43547028110","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","169413013","OZEMPIC","1MG\/DOSE(4MG\/3ML)","3","Select","Select",""],["","597014090","TRADJENTA","5MGTABLET","30","Select","Select",""],["","65862020399","LOSARTAN","POTASSIUM100MGTAB","30","Select","Select",""],["","2879959","HUMALOG","100UNIT\/MLKWIKPEN","15","Select","Select",""],["","65862018601","CLINDAMYCIN","HCL300MGCAPSULE","40","Select","Select",""],["","55111072901","ALLOPURINOL","100MGTABLET","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","378395177","ATORVASTATIN","20MGTABLET","30","Select","Select",""],["","68382065001","ISOSORBIDE","MONONITER30MGTB","30","Select","Select",""],["","61958250101","BIKTARVY","50-200-25MGTABLET","30","Select","Select",""],["","69097012805","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","68462026430","ROSUVASTATIN","CALCIUM40MGTAB","30","Select","Select",""],["","67877022301","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","228203110","ALPRAZOLAM","1MGTABLET","20","Select","Select",""],["","57664080099","OLMSRTN-AMLDPN-HCTZ","40-10-25MG","30","Select","Select",""],["","143980350","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","62559043130","HYDROCORTISONE","0.025CREAM","30","Select","Select",""],["","67877032001","IBUPROFEN","600MGTABLET","20","Select","Select",""],["","228212810","CLONIDINE","HCL0.2MGTABLET","60","Select","Select",""],["","378064110","PREDNISONE","10MGTABLET","21","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":""}]}]}