{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ashley N WRIGHT","gend":1,"add":"603 Old Henry Grady Rd","city":"Dawsonville","state":"GA","zip":30534,"dob":"1998-06-04","age":"","mstatus":"","insh":4743562001,"cliId":"","pno":7065258237,"cno":"","email":"awright71318@gmail.com","ename":"","eno":"","pphy":"William Keating","ppno":"","pcpadd":"1080 Lumpkin Campground Road S Ste 300","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":["I10","Z97.5","Z86.711","R11.0","R20.2","R14.1","F33.9","F33.2","I82.621","K62.5","Z23","K62.89","Z68.30","J02.9","F41.9","E66.9","Z79.899","M10.09","M32.19","M33.20","E55.9","R76.8","M05.79","D68.61","B19.9","M45.6","N39.0","J21.9","R07.89","R06.00","R45.851","Z11.59","M79.7","M25.50","R53.82","Z86.718","G25.81","J06.9","K21.9","F32.9","B96.89","R05.9","M25.531","F60.9","F33.40","F41.1","M65.4","R63.5","Z68.34","F33.1","F33.0","R06.02","Z79.01","R10.2","I82.721","N93.8","J01.40","Z13.89","Z68.29","F32.2","Z68.33","K59.09","M79.604","M79.605","Z20.822","R51.9","R10.30","N92.0","R07.9","R29.898","G47.09","Z68.35","G43.819","M54.5","Z68.32","G89.29","Z00.01","Z51.81","J98.4","E61.1","G43.909","D50.9","R53.83","M79.601","J18.9","G47.00","Z01.419","Z11.3","G62.89","M79.609","R45.86","F51.01","K63.5","K57.30","K64.1","H47.291","J01.00","K59.04","H53.9","Z01.89","Z68.31","S63.521","H53.10","S81.012","Z68.36","Z30.433","Z32.02","Z20.828","M79.622","T50.B95","K58.2","R25.2","Z30.432","K60.2","Z03.818","R05","D12.5","J98.11","R22.43","K92.1","R07.0","J20.8","J01.01","J20.2"],"date":["2021-11-23","2021-07-06","2021-12-14","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-01-26","2021-12-14","2021-02-11","2021-05-25","2021-01-12","2020-10-06","2021-12-28","2021-12-28","2021-11-23","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-10-06","2021-10-06","2021-11-23","2020-06-09","2020-06-02","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-06-22","2020-12-15","2021-12-07","2020-03-24","2020-03-17","2021-12-07","2021-06-29","2020-12-08","2021-05-25","2021-05-11","2021-05-25","2021-06-01","2021-07-06","2021-11-30","2021-11-23","2021-12-28","2021-07-06","2021-05-18","2022-01-06","2021-07-06","2020-03-03","2020-07-28","2020-03-03","2021-12-14","2021-04-06","2020-02-11","2021-12-14","2021-12-14","2021-11-23","2021-08-24","2021-06-15","2021-06-15","2021-09-14","2021-06-08","2021-11-23","2021-08-17","2021-08-10","2020-09-15","2020-12-08","2020-09-15","2020-07-28","2020-07-28","2020-12-29","2021-06-22","2021-09-21","2021-09-21","2021-09-21","2021-07-13","2021-12-28","2020-06-09","2021-04-27","2021-04-27","2021-08-03","2021-08-03","2020-10-06","2020-10-06","2020-10-06","2020-12-01","2020-12-01","2021-08-10","2020-03-24","2020-11-10","2021-07-20","2021-02-02","2020-12-15","2021-07-13","2021-08-05","2021-05-18","2021-12-14","2021-03-02","2021-03-02","2020-12-15","2021-06-08","2021-06-08","2021-09-21","2021-09-01","2021-06-15","2021-02-11","2020-06-02","2020-06-02","2020-12-01","2021-11-23","2021-07-13","2020-09-08","2020-04-09","2021-11-23","2020-12-08","2020-12-08"],"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":[["","59148003813","REXULTI","2MGTABLET","30","Select","Select",""],["","68382080701","TRAZODONE","150MGTABLET","30","Select","Select",""],["","10702000709","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","55111053401","DIVALPROEX","SODER500MGTAB","60","Select","Select",""],["","57237001930","DULOXETINE","HCLDR60MGCAP","30","Select","Select",""],["","67877022310","GABAPENTIN","300MGCAPSULE","90","Select","Select",""],["","52817031910","BACLOFEN","5MGTABLET","30","Select","Select",""],["","59746017310","PREDNISONE","10MGTABLET","39","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","118","Select","Select",""],["","72205001390","PREGABALIN","75MGCAPSULE","60","Select","Select",""],["","3089421","ELIQUIS","5MGTABLET","60","Select","Select",""],["","68645056259","IBUPROFEN","600MGTABLET","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","65162019011","NAPROXEN","500MGTABLET","14","Select","Select",""],["","33342029907","ESZOPICLONE","1MGTABLET","30","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","10","Select","Select",""],["","68180071160","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","49035056317","EQ","ASPIRINEC81MGTABLET","30","Select","Select",""],["","43547026910","ROPINIROLE","HCL0.5MGTABLET","90","Select","Select",""],["","65862062690","RIZATRIPTAN","10MGODT","12","Select","Select",""],["","93310905","AMOXICILLIN","500MGCAPSULE","20","Select","Select",""],["","68180016011","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","69097014260","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","143924920","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","69452014320","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","20","Select","Select",""],["","55111015330","ONDANSETRON","HCL4MGTABLET","24","Select","Select",""],["","49281042150","FLUZONE","QUAD2021-2022SYRINGE","0.5","Select","Select",""],["","406048410","ACETAMINOPHEN-COD","#3TABLET","10","Select","Select",""],["","31722071390","PANTOPRAZOLE","SODDR40MGTAB","60","Select","Select",""],["","13668021730","ARIPIPRAZOLE","5MGTABLET","15","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","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":""}]}]}