{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON WHITLOCK","gend":1,"add":"534 Chubby Smith Rd","city":"Toccoa","state":"GA","zip":30577,"dob":"1970-11-22","age":"","mstatus":"","insh":817903001,"cliId":"","pno":7065996424,"cno":"","email":"sharonwhitlock70@yahoo.com","ename":"","eno":"","pphy":"Stephen Little","ppno":"","pcpadd":"1315 Jesse Jewell Pkwy,Suite 20","pcpcity":"Gainesville","pcpstate":"GA","pcpzip":"","pcpcounty":"Gainesville","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":["Z20.822","J02.9","Z68.28","N65.0","Z85.3","Z90.13","Z79.899","Z87.891","J01.90","F41.9","Z03.818","Z20.828","G47.30","K21.9","E07.89","Z01.818","N39.0","R05","N65.1","C50.512","Z13.31","Z79.811","M85.89","Z17.0","E03.8","G47.33","Z80.41","R22.2","Z68.27","R30.0","E55.9","M85.88","R10.2","Z01.419","T78.40X","N64.89","E03.9","E78.2","Z85.850","J01.00","M54.6","G62.0","Z68.26","R68.84","K04.7","T85.49X","J01.10","T63.441","Z23","L03.114","G47.00","E89.0","D50.8","R37","U07.1","A41.9","R65.21","J96.00","M79.671","N76.0","N89.8","B96.89","T85.42X","M23.91","S83.231","S83.271","S83.511","J20.8","J01.01","R05.9","N81.9","J06.9","C73","C50.919","S83.411","N30.10","R31.29","G50.0","Z86.69","M25.461","R19.7","R11.2","Z00.00","M25.561","R09.81","B34.9","J06.0","R06.2","Q07.00","V89.2XX","S83.521","R51.9","R65.10","R50.9"],"date":["2021-12-07","2022-01-06","2021-02-23","2021-03-16","2021-12-14","2021-04-20","2021-06-08","2021-12-07","2021-03-23","2021-04-20","2021-03-23","2021-03-23","2020-12-08","2021-12-07","2020-12-08","2020-12-08","2021-12-28","2021-09-14","2021-12-28","2021-10-19","2021-10-19","2021-10-19","2021-04-20","2021-10-19","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-10-19","2022-01-04","2021-10-19","2021-10-19","2020-08-04","2020-12-22","2021-12-21","2021-12-07","2021-12-07","2021-10-26","2021-10-26","2021-11-23","2022-01-06","2021-11-23","2021-12-21","2020-10-20","2020-10-20","2021-03-30","2021-03-02","2020-10-13","2021-10-26","2020-10-13","2021-07-06","2021-05-18","2020-10-13","2021-06-29","2022-01-04","2021-11-23","2021-11-23","2021-11-23","2021-06-22","2021-10-05","2021-10-05","2021-10-05","2021-12-14","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2021-12-07","2021-12-07","2021-12-21","2020-12-22","2021-05-18","2021-06-08","2021-06-08","2021-09-28","2021-07-06","2021-10-26","2021-11-09","2021-10-26","2021-11-23","2021-02-02","2021-02-02","2021-06-08","2021-09-28","2021-12-28","2021-12-28","2020-01-22","2020-01-22","2020-01-22","2021-09-28","2021-08-24","2021-11-18","2021-03-23","2021-03-16"],"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":[["","69238183701","LEVOTHYROXINE","137MCGTABLET","30","Select","Select",""],["","65162063711","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","68462038401","ESZOPICLONE","3MGTABLET","30","Select","Select",""],["","93083205","CLONAZEPAM","0.5MGTABLET","30","Select","Select",""],["","65862001905","CEPHALEXIN","500MGCAPSULE","20","Select","Select",""],["","16714038802","CEFADROXIL","500MGCAPSULE","6","Select","Select",""],["","65162062750","TRAMADOL","HCL50MGTABLET","20","Select","Select",""],["","6033530","BELSOMRA","20MGTABLET","30","Select","Select",""],["","65162010150","GABAPENTIN","100MGCAPSULE","90","Select","Select",""],["","469260230","MYRBETRIQ","ER50MGTABLET","30","Select","Select",""],["","60432060416","PROMETHAZINE-DM","SYRUP","240","Select","Select",""],["","68001042300","NITROFURANTOIN","MONO-MCR100MG","10","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","4","Select","Select",""],["","59746017210","PREDNISONE","5MGTABLET","30","Select","Select",""],["","69097031602","EXEMESTANE","25MGTABLET","30","Select","Select",""],["","68180098430","BUDESONIDE","0.5MG\/2MLSUSP","60","Select","Select",""],["","59310057922","PROAIR","HFA90MCGINHALER","8.5","Select","Select",""],["","68001024717","ONDANSETRON","ODT8MGTABLET","20","Select","Select",""],["","68001016208","PROMETHAZINE","25MGTABLET","20","Select","Select",""],["","42571016242","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","65862053650","LEVOFLOXACIN","250MGTABLET","10","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","65862064169","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","67877014701","TEMAZEPAM","30MGCAPSULE","30","Select","Select",""],["","68001036103","MONTELUKAST","SOD10MGTABLET","30","Select","Select",""],["","55111012705","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","57237003750","CEFPROZIL","500MGTABLET","20","Select","Select",""],["","52817033200","CYCLOBENZAPRINE","10MGTABLET","30","Select","Select",""],["","406051201","OXYCODONE-ACETAMINOPHEN","5-325","20","Select","Select",""],["","65162020710","OXYCODON-ACETAMINOPHEN","7.5-325","20","Select","Select",""],["","68001036206","CEFDINIR","300MGCAPSULE","20","Select","Select",""],["","781707787","METRONIDAZOLE","VAGINAL0.0075GL","70","Select","Select",""],["","68180096301","ALBUTEROL","HFA90MCGINHALER","8.5","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":""}]}]}