{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gary Coltek","gend":0,"add":"108 Old Mill Pond Rd","city":"Mineral Bluff","state":"GA","zip":30559,"dob":"1959-11-01","age":"","mstatus":"","insh":4769837001,"cliId":"","pno":4046618827,"cno":"","email":"gary@chefdemands.com","ename":"","eno":"","pphy":"DANA CONNER","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","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","Z79.890","M86.671","F17.210","Z86.13","Z79.82","Z79.84","Z82.49","Z89.422","Z89.421","J34.2","J32.1","J32.2","J34.3","M95.0","I10","E78.00","Z79.899","Z79.51","Z87.891","I25.10","M79.675","M25.512","M86.9","M75.42","M75.52","S46.012","E78.5","M79.674","M79.671","L03.119","N52.9","I70.90","M19.012","R13.19","R09.81","J32.0","R09.82","J34.89","M86.171","Z79.891","E11.49","S98.139","G89.29","L97.519","Z79.02","E11.69","Z12.11","Z86.010","K52.89","Z98.890","M75.122","G50.1","E11.621","K21.9","Q30.8","L03.031","E11.40","M79.2","S99.921","J43.2","E11.51","R63.8","Z20.828","E11.52","B54","S93.601","L03.032","Z01.818","M79.89","F41.1","R41.3","I70.0","R05.9"],"date":["2021-09-07","2021-09-07","2020-08-04","2021-03-09","2021-03-09","2021-07-06","2021-07-13","2020-08-04","2020-08-04","2020-08-04","2021-08-24","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-11-09","2021-07-06","2021-07-06","2021-07-06","2020-09-15","2020-09-15","2021-07-13","2020-09-15","2020-09-15","2020-09-15","2021-09-07","2021-03-30","2021-01-12","2020-12-15","2020-12-15","2020-12-15","2020-08-04","2021-05-04","2021-06-22","2021-07-06","2021-06-22","2021-07-06","2020-08-04","2021-11-09","2020-07-07","2020-07-07","2020-07-07","2021-03-09","2021-03-09","2020-08-04","2021-12-16","2021-12-16","2021-12-16","2021-01-12","2020-08-04","2021-06-15","2021-03-09","2020-05-26","2021-05-04","2020-10-20","2020-10-20","2021-07-13","2021-07-13","2021-12-21","2021-07-13","2021-07-13","2020-11-24","2020-08-11","2020-08-11","2021-03-16","2020-09-01","2021-06-15","2020-10-20","2020-08-25","2021-04-20","2021-12-21","2021-12-21"],"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":[["","65862007701","CIPROFLOXACIN","HCL500MGTAB","28","Select","Select",""],["","169413212","OZEMPIC","0.25-0.5MGDOSEPEN","1.5","Select","Select",""],["","65862035790","CLOPIDOGREL","75MGTABLET","30","Select","Select",""],["","76385012810","METFORMIN","HCLER500MGTABLET","120","Select","Select",""],["","42858010401","OXYCODONE-ACETAMINOPHEN","10-325","84","Select","Select",""],["","55111032201","GLIMEPIRIDE","4MGTABLET","30","Select","Select",""],["","378292277","TELMISARTAN","80MGTABLET","30","Select","Select",""],["","68180036109","FENOFIBRATE","145MGTABLET","30","Select","Select",""],["","70377000712","ROSUVASTATIN","CALCIUM10MGTAB","30","Select","Select",""],["","68180018001","CEFADROXIL","500MGCAPSULE","14","Select","Select",""],["","68462063945","NITROGLYCERIN","0.4MGTABLETSL","25","Select","Select",""],["","67877019905","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","20","Select","Select",""],["","143972601","TESTOSTERON","CYP2000MG\/10ML","10","Select","Select",""],["","69097084615","CYCLOBENZAPRINE","10MGTABLET","90","Select","Select",""],["","228202950","ALPRAZOLAM","0.5MGTABLET","60","Select","Select",""],["","80777027310","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","69097086907","NADOLOL","80MGTABLET","60","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","14","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMIN","5-325MG","30","Select","Select",""],["","16714039102","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","60505083305","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","65862018501","CLINDAMYCIN","HCL150MGCAPSULE","30","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","143928501","AMOXICILLIN","875MGTABLET","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":""}]}]}