{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Krystal Black","gend":1,"add":"28 Youngstown Rd","city":"Flat Rock","state":"AL","zip":35966,"dob":"1983-12-25","age":"","mstatus":"","insh":"AM0039006001","cliId":"","pno":"(706) 879-2366","cno":"","email":"","ename":"","eno":"","pphy":"Jose Justiniano-Ayala","ppno":"","pcpadd":"205 Jenkins Rd","pcpcity":"Rossville","pcpstate":"GA","pcpzip":"","pcpcounty":"Rossville","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":["Z20.828","J02.0","J02.9","Z68.32","E66.8","Z68.31","R53.83","R07.0","R10.32","Z11.59","R19.7","M54.2","Z68.30","M54.5","M99.03","M62.49","N92.5","R45.86","U07.1","Z11.52","R05","Z68.35","K21.00","Z01.419","Z11.3","Z11.51","J20.8","K57.90","Z87.19","R13.19","R94.6","Z68.38","M79.605","D22.5","L81.8","M79.672","S90.32X","S93.602","W19.XXX","K21.9","R52","E66.09","Z71.3","Z71.82","K59.09","K29.80","F33.1","M53.86","M62.830","F41.8","Z68.39","R10.84","Z68.33","R20.0","R20.2","Z68.34","K57.92","F41.9","J02.8","Z11.8","K44.9","K50.90","K57.30","K20.9","S39.012","R50.9","Z13.31","N76.1","H16.223","N13.4","K50.919","F60.6","R13.10","F43.22","S93.601"],"date":["2020-12-08","2020-12-08","2021-11-09","2021-03-16","2021-06-22","2020-06-16","2020-06-02","2021-11-09","2020-06-30","2020-06-23","2020-06-30","2021-06-22","2020-09-08","2021-08-03","2021-11-02","2021-06-29","2020-09-08","2020-09-08","2021-09-21","2021-03-16","2021-09-07","2021-11-09","2021-11-09","2020-11-24","2020-11-24","2020-11-24","2021-03-16","2020-06-16","2020-06-16","2020-06-16","2020-09-08","2020-09-08","2020-03-03","2020-08-25","2020-08-25","2020-12-29","2020-12-29","2021-01-12","2020-12-29","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-07-07","2021-12-14","2021-11-02","2021-11-02","2020-08-25","2020-06-09","2021-04-13","2021-04-13","2021-06-22","2021-06-22","2021-11-09","2020-09-08","2021-11-09","2021-11-09","2020-11-24","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-07-21","2020-02-11","2020-06-30","2020-06-30","2021-12-14","2020-10-06","2020-06-02","2020-12-22"],"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":[["","42858010301","OXYCODON-ACETAMINOPHEN","7.5-325","20","Select","Select",""],["","93310905","AMOXICILLIN","500MGCAPSULE","30","Select","Select",""],["","43199001401","HYOSCYAMINE","ER0.375MGTAB","60","Select","Select",""],["","93317431","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","31722070530","VALACYCLOVIR","HCL1GRAMTABLET","28","Select","Select",""],["","172392570","DIAZEPAM","2MGTABLET","40","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","68682045570","METRONIDAZOLE","VAGINAL0.0075GL","70","Select","Select",""],["","603533715","PREDNISONE","5MGTABDOSEPACK","21","Select","Select",""],["","69097084507","CYCLOBENZAPRINE","5MGTABLET","7","Select","Select",""],["","68462010530","ONDANSETRON","HCL4MGTABLET","10","Select","Select",""],["","13668013601","ESCITALOPRAM","10MGTABLET","90","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MGTABLET","10","Select","Select",""],["","59267100002","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","62175061743","PANTOPRAZOLE","SODDR40MGTAB","30","Select","Select",""],["","65862007701","CIPROFLOXACIN","HCL500MGTAB","28","Select","Select",""],["","59651000305","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","72578000118","DOXYCYCLINE","HYCLATE100MGTAB","60","Select","Select",""],["","574230145","TRETINOIN","0.0001GEL","45","Select","Select",""],["","93321205","CLONAZEPAM","1MGTABLET","30","Select","Select",""],["","68180016011","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","16571020106","DICLOFENAC","SODEC75MGTAB","60","Select","Select",""],["","93221001","SUCRALFATE","1GMTABLET","28","Select","Select",""],["","60505025203","TIZANIDINE","HCL4MGTABLET","45","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":""}]}]}