{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Melodie Wilson","gend":1,"add":"432 Wilson Rd","city":"Butler","state":"GA","zip":31006,"dob":"1974-11-23","age":"","mstatus":"","insh":5104958001,"cliId":"","pno":4783912933,"cno":"","email":"melodiewilson23@gmail.com","ename":"","eno":"","pphy":"Layth Saymeh","ppno":"","pcpadd":"440 Charter Boulevard,Suite 220","pcpcity":"Macon","pcpstate":"GA","pcpzip":"","pcpcounty":"Macon","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":["R19.7","N76.0","I10","F41.0","F41.1","F31.60","Z86.16","Z68.41","H65.91","R07.0","R05","R52","R11.0","H92.01","Z11.52","Z68.42","Z20.822","Z13.31","Z71.3","Z71.82","Z87.891","K64.8","K52.9","Z85.3","Z79.899","F17.210","K52.29","R63.4","B37.0","I20.8","R94.31","R06.02","Z82.49","R00.2","F32.9","E87.6","G62.9","K21.9","E27.8","N20.0","K64.9","R10.84","K50.90","Z09","K31.89","K29.70","R10.9","I51.7"],"date":["2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-12-08","2021-09-28","2021-09-28","2021-09-28","2021-10-20","2021-12-08","2021-09-14","2021-09-14","2021-09-14","2021-12-08","2021-12-08","2022-01-06","2021-11-09","2022-01-06","2021-10-20","2021-12-16","2021-12-08","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-18","2021-12-16","2021-11-18","2021-11-23","2021-12-08","2021-10-20","2022-01-06","2022-01-06","2022-01-06","2021-10-26"],"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":[["","50742026103","NIFEDIPINE","ER60MGTABLET","30","Select","Select",""],["","65862067905","ALPRAZOLAM","2MGTABLET","90","Select","Select",""],["","62175012837","ISOSORBIDE","MONONITER30MGTB","30","Select","Select",""],["","62037099910","POTASSIUM","CLER20MEQTABLET","30","Select","Select",""],["","68001041203","GABAPENTIN","800MGTABLET","90","Select","Select",""],["","68001018408","QUETIAPINE","FUMARATE100MGTAB","30","Select","Select",""],["","42806071401","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","62135098505","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","16729022601","SPIRONOLACTONE","50MGTABLET","30","Select","Select",""],["","68462016505","CARVEDILOL","25MGTABLET","60","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","68382003610","VENLAFAXINE","HCLER150MGCAP","30","Select","Select",""],["","57237007630","ONDANSETRON","HCL8MGTABLET","6","Select","Select",""],["","69315031228","PROCTO-MED","HC0.025CREAM","28","Select","Select",""],["","61442010310","DICLOFENAC","SODDR75MGTAB","60","Select","Select",""],["","68180021709","LOSARTAN-HCTZ","100-25MGTAB","30","Select","Select",""],["","68462018022","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","781729685","ALBUTEROL","HFA90MCGINHALER","6.7","Select","Select",""],["","54350049","LIDOCAINE","0.02VISCOUSSOLN","210","Select","Select",""],["","68382000301","AZATHIOPRINE","50MGTABLET","90","Select","Select",""],["","57237003105","AMOXICILLIN","500MGCAPSULE","20","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","7","Select","Select",""],["","72578000801","METRONIDAZOLE","500MGTABLET","30","Select","Select",""],["","121086816","NYSTATIN","100000UNIT\/MLSUSP","224","Select","Select",""],["","62559099212","FLUCONAZOLE","150MGTABLET","2","Select","Select",""],["","11788000110","FOLIC","ACID1MGTABLET","30","Select","Select",""],["","603459315","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","378161001","DICYCLOMINE","10MGCAPSULE","180","Select","Select",""],["","59746017310","PREDNISONE","10MGTABLET","180","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":""}]}]}