{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sasha S Walker","gend":1,"add":"55 Saw Mill Rd","city":"Cedartown","state":"GA","zip":30125,"dob":"1986-09-27","age":"","mstatus":"","insh":4430241001,"cliId":"","pno":4706511308,"cno":"","email":"Sashamorris30125@gmail.com","ename":"","eno":"","pphy":"SUSAN BUTLER-SUMNER","ppno":"","pcpadd":"28 Rome Road SW","pcpcity":"Cave Spring","pcpstate":"GA","pcpzip":"","pcpcounty":"Cave Spring","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":["Z96.659","N18.30","M81.0","Z72.0","Z96.643","A59.01","Z20.822","R94.31","B34.9","K31.89","Z48.815","K81.9","N92.6","A59.9","R10.11","R10.31","D72.829","Z20.828","K81.0","R10.32","R10.33","R11.0","R19.7","R50.9","M25.531","M25.631","M25.431","M67.431","F17.210","I10","R07.89","J30.0","G61.89","M17.0","R10.84","K52.89","R53.83","G47.09","F41.9","J44.9","M46.1","R05.8","R06.2","Z11.59","Z79.899","F328","F32.0","F31.9","Z71.3","L70.9","N95.1","F17.218","K52.9","E87.6","K82.9","A41.9","G56.03","Z32.02","K64.8","M26.603","M53.82","G43.909","R79.89","F33.1","L57.0","E78.5","R10.30","M26.601","R10.9","D72.89","M85.40","D16.21","G56.01","J45.998","E78.49","M25.50","Z13.220","Z13.29","M19.031","D21.11","E11.9","F31.81","Z11.1","K58.9","Z51.81","K64.9","M85.641","F32.89","J01.81","S63.591"],"date":["2022-01-04","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2021-06-01","2021-11-30","2020-08-11","2021-12-28","2021-12-28","2021-04-20","2021-12-21","2021-12-21","2021-04-06","2020-07-21","2020-07-28","2022-01-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-08-17","2020-12-01","2020-12-01","2020-12-01","2021-09-14","2021-09-14","2021-06-15","2021-12-28","2021-06-15","2021-06-15","2020-07-28","2020-09-15","2021-05-18","2020-09-29","2021-07-20","2021-09-07","2020-09-29","2021-11-30","2021-11-30","2021-11-30","2021-05-18","2020-09-15","2020-12-08","2020-12-08","2021-12-28","2021-04-27","2021-04-27","2021-04-27","2020-07-28","2020-07-28","2021-12-28","2020-07-21","2020-07-28","2021-12-21","2020-07-28","2021-07-20","2021-07-20","2021-07-20","2021-07-13","2021-04-27","2021-04-27","2021-02-11","2020-07-28","2021-09-07","2020-08-25","2020-08-04","2020-09-08","2020-09-01","2021-03-16","2021-09-14","2021-11-09","2021-05-18","2021-05-18","2021-05-18","2021-08-17","2021-03-16","2021-02-11","2021-11-09","2020-08-04","2020-08-04","2021-08-24","2020-12-01","2020-09-01","2021-08-24","2021-12-28","2020-09-15"],"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":[["","65862053820","LEVOFLOXACIN","750MGTABLET","5","Select","Select",""],["","68001025320","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","43386006019","GAVILYTE-C","SOLUTION","4000","Select","Select",""],["","68382080510","TRAZODONE","50MGTABLET","90","Select","Select",""],["","67877049030","EZETIMIBE","10MGTABLET","30","Select","Select",""],["","68462039710","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","68001013000","AMLODIPINE-BENAZEPRIL","44105MG","30","Select","Select",""],["","68382014014","TOPIRAMATE","100MGTABLET","60","Select","Select",""],["","68180089273","PIRMELLA","7-7-7-28TABLET","28","Select","Select",""],["","51672416403","METRONIDAZOLE","TOPICAL0.01GEL","60","Select","Select",""],["","69315011610","FUROSEMIDE","20MGTABLET","30","Select","Select",""],["","591079401","DICYCLOMINE","10MGCAPSULE","120","Select","Select",""],["","11788001005","IBUPROFEN","800MGTABLET","90","Select","Select",""],["","93720210","PRAVASTATIN","SODIUM40MGTAB","30","Select","Select",""],["","68382005105","MELOXICAM","15MGTABLET","30","Select","Select",""],["","555032402","HYDROXYZINE","PAM100MGCAP","120","Select","Select",""],["","59746017506","PREDNISONE","20MGTABLET","10","Select","Select",""],["","43547034150","RISPERIDONE","1MGTABLET","60","Select","Select",""],["","406012305","HYDROCODONE-ACETAMIN","5-325MG","20","Select","Select",""],["","65162010250","GABAPENTIN","300MGCAPSULE","60","Select","Select",""],["","93314705","CEPHALEXIN","500MGCAPSULE","21","Select","Select",""],["","68001030900","BUPROPION","HCL100MGTABLET","90","Select","Select",""],["","62332014231","CELECOXIB","200MGCAPSULE","30","Select","Select",""],["","59762374302","CLINDAMYCIN","PH0.01GEL","60","Select","Select",""],["","68001000501","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","173088210","BREO","ELLIPTA200-25MCGINH","60","Select","Select",""],["","173088710","TRELEGY","ELLIPTA100-62.5-25","60","Select","Select",""],["","57664085188","MINOCYCLINE","50MGCAPSULE","30","Select","Select",""],["","63402030830","LATUDA","80MGTABLET","30","Select","Select",""],["","59762040105","SUCRALFATE","1GMTABLET","120","Select","Select",""],["","57237007530","ONDANSETRON","HCL4MGTABLET","10","Select","Select",""],["","68001018008","QUETIAPINE","FUMARATE50MGTAB","30","Select","Select",""],["","169413013","OZEMPIC","1MG\/DOSE(4MG\/3ML)","3","Select","Select",""],["","68180016013","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","120","Select","Select",""],["","55111012705","CIPROFLOXACIN","HCL500MGTAB","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":""}]}]}