{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Catherine Brown","gend":1,"add":"200 McEwen Ct","city":"Perry","state":"GA","zip":31088,"dob":"1992-06-03","age":"","mstatus":"","insh":4802407001,"cliId":"","pno":4789549111,"cno":"","email":"catherine.brown200@gmail.com","ename":"","eno":"","pphy":"KELSAY MCFALL","ppno":"","pcpadd":"1025 Keith Dr","pcpcity":"Perry","pcpstate":"GA","pcpzip":"","pcpcounty":"Perry","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":["F33.1","F41.9","G47.9","E66.01","Z20.828","J01.00","J45.40","L20.89","Z00.00","Z13.31","Z97.3","J45.20","N32.81","Z79.51","Z79.3","Z98.891","F33.0","N39.46","I83.92","G47.33","R06.83","G47.10","M54.5","G89.29","M62.830","E78.5","E11.9","Z13.220","Z23","S51.811","G89.11","M54.9","Z48.02","Z79.899","R73.9","N89.8","F31.81","F41.1","N39.41","R35.0","J02.0","F32.9","N39.3","R31.0","Z01.411","Z30.40","Z11.3","Z11.8","Z68.44","A49.8","R73.03","Z30.017","Z32.02","J45.50","Z30.46","Z30.011","Z83.3","N76.0","Z68.43","Z71.3","N93.9","J30.1"],"date":["2020-09-01","2021-02-03","2020-09-01","2021-11-23","2021-01-06","2021-01-06","2021-04-27","2021-04-27","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-09-28","2021-04-06","2021-04-06","2020-11-03","2020-11-03","2020-11-03","2020-02-11","2020-02-11","2020-02-11","2021-03-30","2021-03-23","2021-03-09","2020-09-08","2021-03-23","2021-08-24","2021-08-24","2021-11-23","2021-12-08","2021-12-08","2021-04-06","2021-04-06","2020-04-09","2020-04-09","2021-04-06","2021-04-06","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-01-06","2021-01-06","2020-06-23","2021-11-23","2021-11-23","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-05-05"],"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":[["","66993058597","FLUTICASONE-SALMETEROL","250-50","60","Select","Select",""],["","68645052354","SERTRALINE","HCL100MGTABLET","30","Select","Select",""],["","45802005536","TRIAMCINOLONE","0.001OINTMENT","80","Select","Select",""],["","10702020101","OXYBUTYNIN","5MGTABLET","60","Select","Select",""],["","68382080601","TRAZODONE","100MGTABLET","30","Select","Select",""],["","50111033402","METRONIDAZOLE","500MGTABLET","14","Select","Select",""],["","68382000810","LAMOTRIGINE","100MGTABLET","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE","5MGTABLET","30","Select","Select",""],["","469260230","MYRBETRIQ","ER50MGTABLET","30","Select","Select",""],["","185067401","HYDROXYZINE","PAM25MGCAP","120","Select","Select",""],["","13668001990","VENLAFAXINE","HCLER75MGCAP","60","Select","Select",""],["","59651017301","DOXEPIN","10MGCAPSULE","30","Select","Select",""],["","29300022019","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","555901658","SPRINTEC","28DAYTABLET","28","Select","Select",""],["","68180044501","QUETIAPINE","FUMARATE25MGTAB","30","Select","Select",""],["","68180096301","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","173071620","ADVAIR","HFA115-21MCGINHALER","12","Select","Select",""],["","832105415","BACLOFEN","10MGTABLET","10","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MGTABLET","10","Select","Select",""],["","67877021905","CEPHALEXIN","500MGCAPSULE","14","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","20","Select","Select",""],["","52433001","NEXPLANON","68MGIMPLANT","1","Select","Select",""],["","49281042010","FLUZONE","QUAD2020-2021VIAL","0.5","Select","Select",""],["","68645056259","IBUPROFEN","600MGTABLET","30","Select","Select",""],["","59310057922","PROAIR","HFA90MCGINHALER","8.5","Select","Select",""],["","55111014512","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","68462053435","TACROLIMUS","0.001OINTMENT","60","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","65862084003","MOXIFLOXACIN","0.005EYEDROPS","3","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":""}]}]}