{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna M McCurry","gend":1,"add":"117 LISA LN","city":"DALTON","state":"GA","zip":30720,"dob":"1966-01-03","age":"","mstatus":"","insh":"AM0004974004","cliId":"","pno":"(706) 272-7216","cno":"","email":"","ename":"","eno":"","pphy":"BRADLEY DELAY","ppno":"","pcpadd":"1114 Professional Blvd","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":["M25.562","K21.9","F32.9","M79.7","M85.89","M79.10","R20.2","Z01.419","R41.840","Z79.899","J01.90","N95.1","G47.09","F34.1","F43.23","R10.9","R05","R10.819","R50.9","Z20.822","Z79.82","Z98.84","Z90.710","Z90.49","Z88.1","M17.12","Z96.652","H10.12","E03.9","R53.83","E56.9","E55.9","D51.9","Z13.6","R68.82","Z00.00","Z13.29","Z13.220","E11.9","R94.4","E78.00","G89.29","G43.009","G47.33","K58.0","Z63.79","E11.69","E66.9","E78.01","E78.1","H04.123","H52.03","H52.223","H52.4","R10.31","R11.10","M79.673","M85.872","Z71.9","Z23","M17.11","Z68.39","G89.18","R30.0","R35.0","R31.0","K76.0","R94.5","M77.10","M15.0","D12.3","K91.5","K92.1","K64.8","Z12.31","L82.1","D22.5","L72.0","L21.8","E66.01","Z47.1","R19.7","F41.1"],"date":["2020-04-09","2021-12-07","2021-12-07","2021-03-16","2021-02-09","2020-02-25","2020-02-25","2021-02-09","2021-05-04","2021-05-04","2021-10-05","2021-11-09","2021-05-04","2021-10-26","2021-05-04","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-08-17","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2020-06-02","2021-02-23","2020-02-11","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2022-01-04","2020-08-25","2020-08-18","2020-08-18","2020-08-18","2021-12-07","2021-12-07","2021-05-04","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-03-30","2021-03-30","2021-06-08","2021-06-15","2021-02-23","2021-05-04","2021-12-14","2021-08-17","2020-03-10","2020-06-02","2020-06-02","2020-06-02","2021-03-16","2020-08-25","2021-02-09","2021-02-09","2021-10-05","2021-12-07","2021-12-07","2021-12-07","2021-04-27","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-03-03","2021-09-14","2021-12-07"],"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":[["","16729013616","CLONAZEPAM","0.5MGTABLET","30","Select","Select",""],["","93506110","HYDROXYZINE","HCL25MGTABLET","30","Select","Select",""],["","55513076002","REPATHA","140MG\/MLSURECLICK","2","Select","Select",""],["","69543013650","TRAMADOL","HCL50MGTABLET","90","Select","Select",""],["","65162083366","DICLOFENAC","SODIUM0.01GEL","300","Select","Select",""],["","65162089703","ARIPIPRAZOLE","5MGTABLET","30","Select","Select",""],["","62559049001","DIPHENOXYLATE-ATROP","2.5-0.025","20","Select","Select",""],["","57237007710","ONDANSETRON","ODT4MGTABLET","10","Select","Select",""],["","13668001105","CITALOPRAM","HBR40MGTABLET","30","Select","Select",""],["","60505083305","AZELASTINE","0.001(137MCG)SPRY","30","Select","Select",""],["","62559043130","HYDROCORTISONE","0.025CREAM","30","Select","Select",""],["","63402030430","LATUDA","40MGTABLET","30","Select","Select",""],["","13668000705","ZOLPIDEM","TARTRATE5MGTABLET","30","Select","Select",""],["","27808003503","HYDROCODONE-ACETAMIN","5-325MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","0.02SHAMPOO","120","Select","Select",""],["","59762045001","COLESTIPOL","HCL1GMTABLET","60","Select","Select",""],["","24208039830","IPRATROPIUM","0.0003SPRAY","30","Select","Select",""],["","45802006436","TRIAMCINOLONE","0.001CREAM","80","Select","Select",""],["","55566670001","CLENPIQ","SOLUTION","320","Select","Select",""],["","42571016242","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","67877022310","GABAPENTIN","300MGCAPSULE","30","Select","Select",""],["","67877057301","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","603533815","PREDNISONE","10MGTABDOSEPACK","21","Select","Select",""],["","61314027105","OLOPATADINE","HCL0.001EYEDROPS","5","Select","Select",""],["","29300012510","MELOXICAM","15MGTABLET","30","Select","Select",""],["","49884046665","CHOLESTYRAMINE","LIGHTPACKET","60","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":""}]}]}