{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert C Hurley","gend":0,"add":"108 Friar Tuck Trl N","city":"Murrayville","state":"GA","zip":30564,"dob":"1969-11-17","age":"","mstatus":"","insh":4397052001,"cliId":"","pno":6788868462,"cno":"","email":"hawk68a@hotmail.com","ename":"","eno":"","pphy":"Ramzi Ghosn","ppno":"","pcpadd":"73 Prestige Lane Ste 103","pcpcity":"Dawsonville","pcpstate":"GA","pcpzip":"","pcpcounty":"Dawsonville","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":["E11.9","I10","Z87.891","S14.109","M50.33","M54.12","M51.36","M54.16","M47.816","M47.894","M47.812","G89.4","M25.511","Z79.891","Z51.81","M50.30","R29.898","R26.89","M62.81","R55","J30.1","J30.5","J30.81","R06.02","R09.81","D51.8","E11.42","E78.2","R90.82","R42","Z20.828","Z11.3","Z71.41","U07.1","J30.2","I16.0","H53.9","D51.9","M79.18","L60.0","L03.032","J06.9","J20.8","G47.33","G47.00","N52.9","R68.82","I67.4","L02.811","I47.1","Z68.41","B35.1","M10.9","M51.04","M54.41","F40.01","R45.4","F41.9","R51","R93.89","R51.9","R53.83","F43.12","M51.16","Z23","S61.011","G47.09","J31.0","L60.1","R63.1","G43.901","R39.81","G25.0","H53.8","H61.23"],"date":["2021-12-28","2021-12-14","2021-05-04","2021-10-05","2021-07-27","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2021-03-09","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2020-11-10","2021-12-14","2021-12-14","2021-02-09","2021-02-09","2020-08-25","2020-03-12","2021-02-09","2020-09-22","2021-12-14","2020-09-29","2020-09-29","2021-04-06","2021-10-05","2021-10-12","2021-10-12","2020-02-25","2020-02-25","2020-02-25","2021-12-14","2021-06-08","2021-02-09","2020-09-08","2021-02-11","2021-03-23","2021-03-23","2021-06-29","2021-12-14","2021-06-15","2021-04-27","2021-04-27","2021-06-29","2021-06-29","2020-09-08","2021-04-06","2021-04-06","2020-10-27","2021-12-14","2020-06-23","2021-04-27","2021-02-09","2021-12-14","2021-02-11","2021-06-29","2021-12-28","2020-10-27","2020-07-21","2020-06-23","2020-06-23","2020-06-23"],"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":[["","6027731","JANUVIA","100MGTABLET","30","Select","Select",""],["","23155010410","METFORMIN","HCL1000MGTABLET","60","Select","Select",""],["","68180012202","CEPHALEXIN","500MGCAPSULE","20","Select","Select",""],["","68382003606","VENLAFAXINE","HCLER150MGCAP","30","Select","Select",""],["","31722053401","METHOCARBAMOL","750MGTABLET","90","Select","Select",""],["","43547039510","GLIMEPIRIDE","2MGTABLET","30","Select","Select",""],["","55111022990","PRAVASTATIN","SODIUM10MGTAB","30","Select","Select",""],["","68462019005","NAPROXEN","500MGTABLET","60","Select","Select",""],["","16714004211","ALLOPURINOL","300MGTABLET","30","Select","Select",""],["","16714062202","ZOLPIDEM","TARTRATE10MGTABLET","30","Select","Select",""],["","169413602","OZEMPIC","1MGDOSEPEN","3","Select","Select",""],["","55111046605","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25MGTAB","30","Select","Select",""],["","16714008210","HYDROXYZINE","HCL25MGTABLET","30","Select","Select",""],["","42806005705","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","31722070210","LOSARTAN","POTASSIUM100MGTAB","30","Select","Select",""],["","16714033002","GABAPENTIN","600MGTABLET","120","Select","Select",""],["","59746017710","CYCLOBENZAPRINE","10MGTABLET","90","Select","Select",""],["","63739005007","OSELTAMIVIR","PHOS75MGCAPSULE","10","Select","Select",""],["","378043701","SPIRONOLACTONE","100MGTABLET","60","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","112","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MGAUTO-INJECT","2","Select","Select",""],["","42858010450","OXYCODONE-ACETAMINOPHEN","10-325","14","Select","Select",""],["","16714007104","BACLOFEN","10MGTABLET","90","Select","Select",""],["","53746054401","PRIMIDONE","50MGTABLET","30","Select","Select",""],["","16714047801","AMOX-CLAV","875-125MGTABLET","28","Select","Select",""],["","13107000401","HYDROCODONE-IBUPROFEN","7.5-200","21","Select","Select",""],["","60432060416","PROMETHAZINE-DM","SYRUP","140","Select","Select",""],["","66993001968","ALBUTEROL","HFA90MCGINHALER","18","Select","Select",""],["","70461032003","FLUCELVAX","QUAD2020-2021SYR","0.5","Select","Select",""],["","93083205","CLONAZEPAM","0.5MGTABLET","30","Select","Select",""],["","310620530","FARXIGA","5MGTABLET","30","Select","Select",""],["","406048401","ACETAMINOPHEN-COD","#3TABLET","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":""}]}]}