{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"alicia graves","gend":1,"add":"704 Morrison Camp Ground Rd NE","city":"Rome","state":"GA","zip":30161,"dob":"1981-09-07","age":"","mstatus":"","insh":4592465001,"cliId":"","pno":7062346789,"cno":"","email":"algraves81@gmail.com","ename":"","eno":"","pphy":"JOHN PITTMAN","ppno":"","pcpadd":"715 E 2nd Avenue SW","pcpcity":"Rome","pcpstate":"GA","pcpzip":"","pcpcounty":"Rome","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","E78.5","I25.2","B19.20","Z79.4","K59.00","K21.9","K76.9","E11.65","E55.9","Z98.890","R20.0","E16.1","E78.2","Z79.899","Z68.41","E66.01","R05","R11.0","R50.9","R42","F17.200","R10.11","K80.50","R10.84","G56.02","F41.9","G47.33","Z87.891","Z20.828","R11.2","R19.7","E66.9","M99.03","M99.05","M54.5","M54.41","R06.02","R51.9","M25.539","R03.1","Z68.38","R10.32","R10.9","L03.311","F17.210","Z00.00","K42.9","J11.1","K42.0","R30.0","M79.604","M79.605","R60.0","K57.92","U07.1","L53.9","W57.XXX"],"date":["2021-09-07","2021-07-13","2021-07-13","2021-07-13","2021-12-28","2020-12-08","2021-09-07","2020-12-08","2021-12-28","2021-12-28","2020-11-17","2020-11-17","2021-12-28","2021-12-28","2021-12-28","2021-06-15","2021-12-28","2021-09-07","2021-08-10","2020-12-08","2020-12-08","2020-12-08","2020-09-08","2020-09-08","2021-07-20","2020-11-24","2020-11-17","2021-09-07","2020-11-17","2021-01-12","2021-07-20","2021-07-20","2021-05-04","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-09-07","2021-09-07","2020-11-24","2020-11-24","2021-12-28","2021-01-19","2021-08-10","2020-10-06","2020-10-06","2020-12-29","2020-02-04","2020-02-18","2020-03-03","2020-08-25","2022-01-06","2022-01-06","2022-01-06","2020-08-04","2021-09-07","2021-09-21","2021-09-21"],"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":[["","16729017301","AMITRIPTYLINE","HCL50MGTAB","30","Select","Select",""],["","68462039710","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","27808015801","ROSUVASTATIN","CALCIUM40MGTAB","30","Select","Select",""],["","33342005510","PIOGLITAZONE","HCL30MGTABLET","30","Select","Select",""],["","68001017903","GLIMEPIRIDE","4MGTABLET","30","Select","Select",""],["","69097082112","GEMFIBROZIL","600MGTABLET","60","Select","Select",""],["","64380075806","ACARBOSE","25MGTABLET","90","Select","Select",""],["","43386035701","HYDROCODONE-ACETAMIN","7.5-325","15","Select","Select",""],["","65862039010","ONDANSETRON","ODT4MGTABLET","6","Select","Select",""],["","64380080707","IBUPROFEN","800MGTABLET","15","Select","Select",""],["","597015330","JARDIANCE","25MGTABLET","30","Select","Select",""],["","50228010605","METFORMIN","HCL850MGTABLET","90","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","10","Select","Select",""],["","24586903","TOUJEO","SOLOSTAR300UNIT\/ML","18","Select","Select",""],["","60505014200","GLIPIZIDE","10MGTABLET","30","Select","Select",""],["","70010075401","METHOCARBAMOL","500MGTABLET","14","Select","Select",""],["","27241011703","FENOFIBRATE","160MGTABLET","30","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","60505009702","PAROXETINE","HCL10MGTABLET","30","Select","Select",""],["","68001025320","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","65862053820","LEVOFLOXACIN","750MGTABLET","10","Select","Select",""],["","8470353001","UNIFINE","PENTIPS8MM31G","100","Select","Select",""],["","62332000231","FAMOTIDINE","40MGTABLET","30","Select","Select",""],["","93310905","AMOXICILLIN","500MGCAPSULE","15","Select","Select",""],["","68001036500","METRONIDAZOLE","500MGTABLET","20","Select","Select",""],["","378819015","CLOBETASOL","0.0005OINTMENT","15","Select","Select",""],["","90166083152","PEN","NEEDLES8MM31G","100","Select","Select",""],["","55111012701","CIPROFLOXACIN","HCL500MGTAB","20","Select","Select",""],["","406048410","ACETAMINOPHEN-COD","#3TABLET","10","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":""}]}]}