{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE MANLY","gend":1,"add":"611 CENTRAL AVE","city":"DALTON","state":"GA","zip":30720,"dob":"1961-09-12","age":"","mstatus":"","insh":"AM0006795002","cliId":"","pno":7062268405,"cno":"","email":"","ename":"","eno":"","pphy":"John Antalis","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":["I10","E78.2","E78.5","K21.9","M79.10","Z79.899","S39.91X","K82.8","K83.8","S02.2XX","S29.9XX","S12.390","M43.12","R19.7","R11.0","R51.9","E55.9","N28.9","M47.812","E87.6","R55","R94.4","M54.2","M54.12","M79.18","G43.709","R26.81","R42","S14.124","Z98.1","Z91.81","R13.13","R11.2","R19.4","R63.4","E86.0","S14.154","S12.300","F44.9","R41.89","M54.16","M47.26","K59.03","M54.81","G43.109","M25.561","Z71.9","R41.82","F33.9","F32.1","K29.30","K58.0","R56.9","N63.12","M54.5","J20.9","Z79.891","F41.9","Z20.822","S14.104","W19.XXX","M54.89","U07.1","Z23","T15.82X","M54.17","S02.92X","S12.301","G89.11","S12.200","M53.2X2","S34.01X","G95.20","W01.0XX","K63.89","R13.10","K29.50","R92.8","Z71.89","K58.2","Z03.818","N63.0","H25.13","H40.013","M47.15","M47.817","H02.9","F44.81","F31.9","M25.519","F41.8","M25.532","M25.531","K31.84","S14.109","H04.123","S32.000","W01.198"],"date":["2022-01-04","2022-01-04","2021-10-19","2021-02-09","2021-02-09","2021-11-02","2021-12-14","2021-12-14","2021-12-14","2021-12-21","2021-12-14","2021-12-21","2021-12-14","2020-12-15","2021-11-30","2020-12-15","2021-07-13","2021-07-13","2021-11-02","2021-02-16","2020-12-08","2021-02-16","2021-12-21","2021-11-02","2021-11-02","2021-12-28","2021-04-13","2021-04-13","2021-10-20","2021-10-20","2021-10-19","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-07-13","2021-09-21","2021-10-19","2021-12-28","2021-12-28","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2020-11-24","2021-12-08","2020-08-11","2022-01-04","2021-11-30","2021-11-30","2021-10-13","2020-06-16","2021-02-09","2021-02-09","2021-02-09","2021-10-19","2021-10-19","2021-10-19","2021-12-21","2021-10-19","2021-10-20","2020-12-15","2020-08-04","2021-11-02","2021-11-30","2021-11-30","2021-11-30","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-02-09","2021-02-09","2021-03-23","2020-08-04","2021-06-29","2021-09-28","2021-02-11","2020-06-23","2021-08-17","2021-12-08","2021-10-05","2021-01-05","2020-08-18","2021-11-18","2021-11-18","2021-02-02","2021-09-21","2021-10-19","2021-10-19","2021-02-16","2021-10-13","2021-08-17","2021-10-19","2021-10-19"],"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":[["","68180032002","BUPROPION","HCLXL300MGTABLET","30","Select","Select",""],["","59385004130","SYMPROIC","0.2MGTABLET","30","Select","Select",""],["","27241002238","ZOLMITRIPTAN","5MGTABLET","10","Select","Select",""],["","50111044101","TRAZODONE","150MGTABLET","30","Select","Select",""],["","68382032001","POTASSIUM","CLER10MEQTABLET","60","Select","Select",""],["","55111018015","TIZANIDINE","HCL4MGTABLET","90","Select","Select",""],["","54429931","FUROSEMIDE","40MGTABLET","90","Select","Select",""],["","62332004060","LAMOTRIGINE","200MGTABLET","60","Select","Select",""],["","555089902","ESTRADIOL","0.5MGTABLET","90","Select","Select",""],["","16571020210","DICLOFENAC","SODEC50MGTAB","60","Select","Select",""],["","69452015120","VITAMIN","D21.25MG(50,000UNIT)","12","Select","Select",""],["","832107330","TOPIRAMATE","ER200MGCAPSULE","30","Select","Select",""],["","23649810","UBRELVY","50MGTABLET","10","Select","Select",""],["","31722088290","ROSUVASTATIN","CALCIUM5MGTAB","90","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MGTABLET","60","Select","Select",""],["","68180021509","LOSARTAN-HCTZ","50-12.5MGTAB","10","Select","Select",""],["","68462010530","ONDANSETRON","HCL4MGTABLET","12","Select","Select",""],["","65862020299","LOSARTAN","POTASSIUM50MGTAB","90","Select","Select",""],["","63402030830","LATUDA","80MGTABLET","30","Select","Select",""],["","42192033901","HYOSCYAMINE","0.125MGTABSL","60","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4MGDOSEPK","21","Select","Select",""],["","51991075033","DULOXETINE","HCLDR40MGCAP","30","Select","Select",""],["","527169505","BUTALB-ACETAMIN-CAFF","50-325-40","45","Select","Select",""],["","406052301","OXYCODONE-ACETAMINOPHEN","10-325","120","Select","Select",""],["","57237000511","FLUCONAZOLE","150MGTABLET","3","Select","Select",""],["","70700026390","LANSOPRAZOLE","DR30MGCAPSULE","180","Select","Select",""],["","2143611","EMGALITY","120MG\/MLPEN","1","Select","Select",""],["","456120230","LINZESS","290MCGCAPSULE","90","Select","Select",""],["","68382073901","MIDODRINE","HCL10MGTABLET","90","Select","Select",""],["","68382013201","TAMSULOSIN","HCL0.4MGCAPSULE","30","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","603255321","BUTALB-ACETAMIN-CAF-COD","50-325","30","Select","Select",""],["","93031401","KETOROLAC","10MGTABLET","20","Select","Select",""],["","24208029505","TOBRAMYCIN-DEXAMETH","OPHTHSUSP","5","Select","Select",""],["","603255321","BUTALB-CAFF-ACETAMINOPH-CODEIN","","60","Select","Select",""],["","2449108","REYVOW","100MGTABLET","4","Select","Select",""],["","42195084010","ACETAMN-CAF-DIHYDRCODEIN","320.5","60","Select","Select",""],["","29300046810","CLONIDINE","HCL0.1MGTABLET","20","Select","Select",""],["","24208050707","LOTEMAX","SM0.0038OPHTHGEL","5","Select","Select",""],["","143992801","CIPROFLOXACIN","HCL500MGTAB","14","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":""}]}]}