{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTAN GRIDER","gend":1,"add":"1235 Beaverdale Rd NE","city":"Dalton","state":"GA","zip":30721,"dob":"1991-02-20","age":"","mstatus":"","insh":"AM1040891001","cliId":"","pno":7065816452,"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":["M54.2","M50.20","M99.01","M99.07","M99.02","M25.519","M47.812","M54.10","R20.2","N92.5","Z79.899","F41.1","F41.0","F33.2","M54.12","F90.0","R41.3","R55","R61","R42","H81.4","L20.9","R41.82","M79.18","M79.601","R03.0","Z01.419","Z13.31","Z11.3","R53.83","M47.22","E22.1","Z30.018","L23.7","R06.00","F17.211","R40.4","F41.3","K31.84","M25.511","M50.10","M79.10","K21.9","M79.7","Z30.44","Z68.20","R25.2","F84.5","I10"],"date":["2021-10-19","2021-10-19","2021-08-10","2021-08-10","2021-08-10","2021-04-13","2021-07-20","2021-07-20","2021-05-11","2020-11-24","2021-11-16","2021-11-09","2021-06-29","2021-06-29","2021-07-20","2021-11-09","2020-11-10","2020-04-09","2020-03-12","2020-03-12","2020-03-12","2021-11-16","2021-02-02","2021-07-20","2021-07-20","2021-09-21","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2021-05-11","2020-11-10","2020-11-10","2020-06-09","2020-03-31","2020-03-31","2021-09-14","2021-09-14","2021-09-14","2021-04-13","2021-04-13","2021-06-15","2021-06-15","2021-06-15","2021-02-16","2021-02-16","2021-09-14","2021-09-14","2021-09-14"],"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":[["","70756080751","LANSOPRAZOLE","DR30MGCAPSULE","30","Select","Select",""],["","43547040750","CLONAZEPAM","1MGTABLET","60","Select","Select",""],["","45802000403","HYDROCORTISONE","0.025CREAM","28","Select","Select",""],["","16714080401","DEXTROAMP-AMPHETAMIN","10MGTAB","60","Select","Select",""],["","24591401","DUPIXENT","300MG\/2MLSYRINGE","4","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","16714061205","SERTRALINE","HCL50MGTABLET","30","Select","Select",""],["","59746017310","PREDNISONE","10MGTABLET","21","Select","Select",""],["","66993060536","ETONOGESTREL-EE","VAGINALRING","1","Select","Select",""],["","69238110002","DOXYCYCLINE","HYCLATE100MGCAP","20","Select","Select",""],["","52817031910","BACLOFEN","5MGTABLET","90","Select","Select",""],["","55724021121","EUCRISA","0.02OINTMENT","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":""}]}]}