{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christine Mcdonald","gend":1,"add":"8475 Staton Rd","city":"Clermont","state":"GA","zip":30527,"dob":"1959-11-28","age":"","mstatus":"","insh":4409043001,"cliId":"","pno":6786163058,"cno":"","email":"jcemc1@aol.com","ename":"","eno":"","pphy":"William Koeppel","ppno":"","pcpadd":"396 Historic Hwy 441 N","pcpcity":"Demorest","pcpstate":"GA","pcpzip":"","pcpcounty":"Demorest","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":["N28.89","K57.30","R07.9","R06.00","K14.6","I10","E78.5","K58.9","Z82.49","Z87.891","R79.89","Z11.59","M54.6","E53.8","G89.29","M79.662","M79.661","R19.7","R11.0","N39.0","R53.1","K44.9","J98.11","M25.50","R00.1","R39.89","R35.0","R10.32","R31.29","R76.0","R51","F41.9","B34.9","R31.9","Z73.3","Z11.4","Z03.818","J06.9","R03.0","M54.9","R07.89","M79.10","R51.9","F41.8","K21.9","K76.0","Z87.19","Z83.3","M79.601","M79.602","Z20.828","R55","K52.9","R42","T46.5X6","Z91.128","I16.0","I07.1","Z79.82","D89.89","Z12.11","Z23","Z13.31","Z68.26","Z12.31","N95.2","R09.89","R50.9","D12.2","K29.60","D12.3","K29.80","K64.0","R10.11","Z68.24","Z01.419","S93.401","R06.82","R25.9","R10.84","M54.2","M54.89","T85.828","E78.2","R39.9","S39.011","M79.18","M25.59","R52","R07.0","I16.9","Z68.22","Z03.89","Z28.3","Z71.9","Z79.899","M79.604","M79.605","F17.210","R63.8","Z68.27","R05","M54.5","R10.9","K92.1","R10.13","E66.3","Z68.25","R06.02","T14.8XX","R45.89","R76.8","K29.00","N63.20","Z68.23","S99.912","R10.30","R68.89","M62.838","J81.1","T78.40X","Z53.21","N63.22","R09.81","R10.31","R92.1","F17.211","R93.1","K52.29","J30.1","K90.49","K11.7","Z98.86","R39.198","N30.00","T78.1XX","L98.9","L08.89","N64.89","J98.4","E78.00"],"date":["2020-09-08","2020-09-08","2021-12-28","2021-01-06","2021-09-01","2021-12-28","2021-12-28","2021-04-06","2021-04-06","2021-12-28","2020-04-09","2021-05-04","2020-08-25","2021-09-01","2021-05-04","2020-12-15","2020-12-15","2021-01-12","2021-01-12","2021-10-19","2021-02-09","2021-02-02","2021-02-02","2021-01-12","2021-01-12","2021-10-05","2021-10-19","2021-10-05","2021-10-05","2021-03-02","2020-10-27","2021-12-28","2020-06-30","2020-06-30","2020-06-30","2021-05-04","2020-08-11","2020-08-11","2021-06-01","2020-09-08","2021-02-09","2020-09-08","2021-06-08","2021-04-06","2021-12-28","2021-04-06","2021-04-06","2021-04-06","2021-01-26","2021-01-26","2021-02-09","2021-04-27","2021-04-27","2021-04-27","2020-10-06","2020-10-06","2020-09-08","2020-08-18","2020-08-18","2021-06-08","2021-01-06","2020-10-20","2021-12-28","2020-10-20","2020-10-20","2020-12-22","2020-06-30","2021-02-09","2021-01-06","2020-12-22","2021-01-06","2020-12-22","2020-12-22","2021-01-12","2021-02-23","2020-12-22","2021-03-02","2020-10-27","2020-10-27","2021-01-12","2020-08-25","2020-08-25","2021-06-01","2021-01-26","2021-03-23","2021-03-23","2021-02-02","2021-02-02","2020-12-08","2020-12-08","2020-12-08","2021-12-28","2020-09-29","2021-09-21","2021-09-21","2021-02-23","2021-01-12","2021-01-12","2020-09-01","2020-10-13","2020-09-01","2020-09-15","2020-09-08","2020-12-15","2020-12-15","2021-05-25","2020-12-15","2020-12-22","2021-02-23","2021-03-09","2020-07-21","2021-02-02","2021-01-06","2021-05-04","2021-05-04","2021-02-23","2020-06-30","2020-09-15","2021-01-12","2020-08-25","2020-10-06","2021-02-23","2021-05-18","2020-09-15","2020-06-23","2021-05-11","2020-10-13","2020-10-13","2021-04-20","2021-04-20","2021-04-20","2021-08-03","2021-07-06","2021-09-28","2021-09-28","2021-04-06","2020-09-15","2020-09-15","2021-05-11","2020-11-10","2020-02-11"],"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":[["","43547039910","CYCLOBENZAPRINE","5MGTABLET","20","Select","Select",""],["","65862001905","CEPHALEXIN","500MGCAPSULE","30","Select","Select",""],["","59762040101","SUCRALFATE","1GMTABLET","120","Select","Select",""],["","42858010401","OXYCODONE-ACETAMINOPHEN","10-325","20","Select","Select",""],["","67877022305","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","68462013801","OXCARBAZEPINE","300MGTABLET","60","Select","Select",""],["","67877019810","AMLODIPINE","BESYLATE5MGTAB","30","Select","Select",""],["","50742061510","METOPROLOL","SUCCER25MGTAB","15","Select","Select",""],["","16729018217","HYDROCHLOROTHIAZIDE","12.5MGTB","30","Select","Select",""],["","57237007530","ONDANSETRON","HCL4MGTABLET","20","Select","Select",""],["","68180018001","CEFADROXIL","500MGCAPSULE","14","Select","Select",""],["","55111018010","TIZANIDINE","HCL4MGTABLET","24","Select","Select",""],["","51862006301","DIAZEPAM","5MGTABLET","8","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","23155050110","HYDROXYZINE","HCL25MGTABLET","60","Select","Select",""],["","68001033308","LISINOPRIL","5MGTABLET","30","Select","Select",""],["","57664037718","TRAMADOL","HCL50MGTABLET","15","Select","Select",""],["","62175089143","ATORVASTATIN","20MGTABLET","30","Select","Select",""],["","62175012841","ISOSORBIDE","MONONITER30MGTB","30","Select","Select",""],["","68382091634","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","50111045602","OXYBUTYNIN","5MGTABLET","14","Select","Select",""],["","67877026410","DULOXETINE","HCLDR30MGCAP","30","Select","Select",""],["","64380073408","HYDRALAZINE","25MGTABLET","60","Select","Select",""],["","68462063945","NITROGLYCERIN","0.4MGTABLETSL","25","Select","Select",""],["","47781030301","NITROFURANTOIN","MONO-MCR100MG","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":""}]}]}