{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Penny Smith","gend":1,"add":"859D McMath mill rd","city":"Americus","state":"GA","zip":31719,"dob":"1963-09-22","age":"","mstatus":"","insh":4735361001,"cliId":"","pno":2299380097,"cno":"","email":"PennySmith@yourmailtoday.com","ename":"","eno":"","pphy":"BENNIE LAW","ppno":"","pcpadd":"122 US Hwy 280 W,Suite ","pcpcity":"Americus","pcpstate":"GA","pcpzip":"","pcpcounty":"Americus","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":["T81.30X","Z86.14","J32.1","R11.0","I10","Z20.822","Z79.2","Z79.899","Z88.1","Z91.048","G92","H05.021","E44.1","J32.0","G47.33","H53.8","F17.210","H02.401","E66.01","D63.8","H49.9","B95.62","R62.7","H53.2","R45.1","R19.7","H05.20","Z68.35","F32.9","F17.200","G89.29","B95.61","K58.0","E66.9","J32.9","Z53.21","B95.1","Z96.651","Z90.710","Z83.3","Z82.49","G06.0","Z71.89","H05.011","D64.9","R80.9","R31.9","R11.2","D72.829","E86.0","Z79.1","J01.00","L30.8","H44.001","G08","L98.499","Z51.81","D84.9","H05.019","Z00.00","M70.21","H53.9","M50.30","M51.36","R21","J32.8","G06.2","A41.9","E43","L89.159","Z23","M54.9","G62.9","F32.A","L97.529","L97.519","G47.00","D50.9","E53.8","R60.0","L98.492","M31.30","H05.10","H57.11","J01.01","H05.89","R53.1","Z74.3","B37.89","H44.19","T36.0X6","T36.1X6","T36.4X6","Z91.128","B96.89","E87.6","E83.42","T36.8X5","Z90.01","J01.11","H05.221","A41.01","J43.9","L10.9","D64.89","L10.89","H05.111","Z68.36","J32.3","J32.2","L03.90","F32.1","F31.81","D80.1","R90.82","J01.90","A49.01","A49.1","Z72.0","L03.213","Z45.2","H00.033","H02.402","H54.7","R91.8","R93.7","R42","R51.9","H25.13","H05.411","H57.9","R52","M27.2","L30.9","R41.82","R53.81","Z03.818","Z11.59","H70.019","M19.91","B95.2","M62.50","R26.9","F33.9","K58.9","M54.5","B37.9","I49.8","I96","I33.0","Z53.29","R26.89","R26.81","S09.90X","D71","E55.9","G47.09","H57.89","I11.9","I36.1","I34.0","A49.02","R22.31","R82.90","H57.10","I38","M47.816","M48.061","I77.6"],"date":["2021-12-21","2021-12-21","2021-12-21","2021-12-21","2022-01-06","2021-12-28","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-28","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-28","2021-12-21","2021-09-01","2021-11-23","2021-12-28","2021-07-20","2021-09-01","2021-08-10","2021-12-28","2021-07-20","2021-07-20","2021-11-23","2021-11-23","2021-07-20","2021-07-20","2021-12-28","2021-07-13","2022-01-06","2022-01-06","2021-12-28","2021-12-28","2021-11-30","2021-11-23","2021-11-23","2021-11-23","2021-10-13","2021-11-23","2021-12-28","2022-01-06","2021-12-28","2021-12-08","2021-11-23","2021-11-02","2021-08-05","2021-04-06","2021-04-06","2021-04-06","2022-01-06","2021-12-16","2021-11-02","2021-09-14","2021-07-27","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-16","2021-12-28","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-11-30","2021-12-16","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-12-28","2021-08-05","2021-08-05","2021-08-05","2021-11-23","2022-01-06","2022-01-06","2021-12-16","2021-08-10","2021-08-10","2021-07-13","2021-11-02","2021-08-24","2022-01-06","2021-04-06","2021-11-18","2021-11-23","2021-12-16","2021-09-14","2021-07-27","2021-11-02","2021-09-14","2021-09-14","2021-09-22","2021-08-10","2021-08-17","2021-11-23","2021-09-01","2021-09-01","2021-09-01","2021-06-29","2021-11-30","2021-07-20","2021-12-16","2021-08-10","2021-09-07","2021-12-16","2021-12-16","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-08-24","2021-11-23","2021-11-23","2021-07-13","2021-12-16","2021-12-16","2021-12-08","2022-01-06","2022-01-06","2022-01-06","2021-08-17","2021-12-28","2021-12-28","2021-12-28","2021-12-08","2021-11-09","2021-04-06","2021-08-05","2021-10-26","2021-11-09","2021-11-09","2021-11-09"],"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":[["","591079501","DICYCLOMINE","20MGTABLET","120","Select","Select",""],["","62559049001","DIPHENOXYLATE-ATROP","2.5-0.025","30","Select","Select",""],["","68382000905","LAMOTRIGINE","150MGTABLET","8","Select","Select",""],["","47781019601","OXYCODONE-ACETAMINOPHEN","5-325","28","Select","Select",""],["","185041501","BUPROPION","HCLSR150MGTABLET","60","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","28","Select","Select",""],["","3089421","ELIQUIS","5MGTABLET","24","Select","Select",""],["","24208048610","DORZOLAMIDE-TIMOLOL","EYEDROPS","10","Select","Select",""],["","264315511","CEFTRIAXONE","2GM-D5WBAG","1","Select","Select",""],["","832532510","POTASSIUM","CLER20MEQTABLET","60","Select","Select",""],["","55150020830","MEROPENEM","IV1GMVIAL","3","Select","Select",""],["","42858080101","MORPHINE","SULFER15MGTABLET","30","Select","Select",""],["","67877019910","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","67877022305","GABAPENTIN","300MGCAPSULE","150","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","30","Select","Select",""],["","59746017506","PREDNISONE","20MGTABLET","84","Select","Select",""],["","781531501","ZOLPIDEM","TARTER6.25MGTAB","30","Select","Select",""],["","69238110005","DOXYCYCLINE","HYCLATE100MGCAP","42","Select","Select",""],["","16729017217","AMITRIPTYLINE","HCL25MGTAB","30","Select","Select",""],["","8290306546","NORMAL","SALINEFLUSHSYRINGE","300","Select","Select",""],["","93738556","VENLAFAXINE","HCLER75MGCAP","30","Select","Select",""],["","43598074130","RAMELTEON","8MGTABLET","30","Select","Select",""],["","69315012701","FOLIC","ACID1MGTABLET","30","Select","Select",""],["","64380073706","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","43598096530","ARIPIPRAZOLE","2MGTABLET","30","Select","Select",""],["","51991081403","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","42571016242","AMOX-CLAV","875-125MGTABLET","30","Select","Select",""],["","65862018830","ONDANSETRON","HCL8MGTABLET","12","Select","Select",""],["","57664050389","TIZANIDINE","HCL4MGTABLET","30","Select","Select",""],["","55111014601","FLUCONAZOLE","200MGTABLET","20","Select","Select",""],["","24208091055","ERYTHROMYCIN","0.005EYEOINTMENT","3.5","Select","Select",""],["","338004902","SODIUM","CHLORIDE0.009SOLUTION","6","Select","Select",""],["","23155000101","HYDRALAZINE","10MGTABLET","90","Select","Select",""],["","781312595","NAFCILLIN","2GMVIAL","2","Select","Select",""],["","168009915","KETOCONAZOLE","0.02CREAM","15","Select","Select",""],["","67877025001","QUETIAPINE","FUMARATE100MGTAB","30","Select","Select",""],["","67877021905","CEPHALEXIN","500MGCAPSULE","21","Select","Select",""],["","57664037718","TRAMADOL","HCL50MGTABLET","60","Select","Select",""],["","42858000201","OXYCODONE","HCL(IR)10MGTAB","24","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}