{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ernestina Maldonado Meza","gend":1,"add":"1481 Hale Bowen Dr","city":"Dalton","state":"GA","zip":30721,"dob":"1968-02-25","age":"","mstatus":"","insh":4830188001,"cliId":"","pno":7066180630,"cno":"","email":"ernestinajafra@gmail.com","ename":"","eno":"","pphy":"PABLO PEREZ","ppno":"","pcpadd":"1102 W Waugh St","pcpcity":"Dalton","pcpstate":"GA","pcpzip":"","pcpcounty":"Dalton","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":["R07.9","M79.10","M54.5","T14.8XX","M05.19","E88.81","N99.531","E11.9","I10","R30.0","R05","Z20.828","Z79.84","L28.1","D48.5","L25.9","F32.1","Z00.01","Z12.4","L72.0","L24.3","E04.1","N30.00","B37.3","K58.0","R06.02","Z12.31","E78.5","L30.0","J31.0","K21.9","M79.7","K25.9","R10.84","K21.0","K27.9","K29.70","R10.11"],"date":["2021-04-27","2021-04-27","2021-06-01","2021-05-04","2020-11-03","2021-04-06","2021-04-06","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-10-20","2020-11-17","2020-11-17","2021-04-27","2021-04-06","2020-02-18","2020-02-18","2020-02-18","2021-09-02","2021-04-27","2021-04-27","2021-04-27","2020-11-17","2021-05-04","2021-04-06","2020-12-15","2021-07-27","2021-07-27","2020-11-24","2020-11-24","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2020-11-10"],"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":[["","68645052154","SERTRALINE","HCL25MGTABLET","30","Select","Select",""],["","67877021905","CEPHALEXIN","500MGCAPSULE","28","Select","Select",""],["","68382009716","PAROXETINE","HCL10MGTABLET","30","Select","Select",""],["","57664037713","TRAMADOL","HCL50MGTABLET","20","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","49281072010","FLUBLOK","QUAD2020-2021SYRINGE","0.5","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TMP","DSTABLET","6","Select","Select",""],["","65162067684","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","59651000330","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","65162047810","NITROFURANTOIN","MONO-MCR100MG","10","Select","Select",""],["","29033000305","SUCRALFATE","1GMTABLET","90","Select","Select",""],["","527058601","DICYCLOMINE","10MGCAPSULE","30","Select","Select",""],["","55111014512","FLUCONAZOLE","150MGTABLET","2","Select","Select",""],["","45802000403","HYDROCORTISONE","0.025CREAM","28","Select","Select",""],["","59762444002","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","10702000709","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","49281041950","FLUZONE","QUAD2019-2020SYRINGE","0.5","Select","Select",""],["","57237001930","DULOXETINE","HCLDR60MGCAP","30","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":""}]}]}