{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Harold M Storey","gend":0,"add":"17 Saddlebrook Drive","city":"Rome","state":"GA","zip":30161,"dob":"1957-09-25","age":"","mstatus":"","insh":"AM1053471001","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Shannon Vaughn","ppno":"","pcpadd":"330 Turner McCall Blvd,Suite 10","pcpcity":"Rome","pcpstate":"GA","pcpzip":"","pcpcounty":"Rome","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":["R22.41","I82.441","Z79.01","I10","E10.9","Z23","R53.1","R07.1","R00.0","Z79.4","E78.5","I48.0","Z68.37","E78.49","R94.39","E11.9","R68.84","Z20.828","E11.65","K02.9","E66.01","Z79.02","Z79.82","Z68.38","I48.20","L03.115","M86.171","G47.33","Z96.41","E78.2","E10.329","R07.89","R06.02","E11.42","B35.1","M16.12","M79.674","E10.22","E66.9","G63","N18.2","I48.91","Z12.5","E10.65","Z51.89","I16.0","S92.421","G89.11","Z68.39","Z11.59","R94.31","I50.32","L60.0","L60.3","M79.675","I82.449","Z92.89","M25.552","R53.83","S91.201","W23.0XX","L03.119","L02.619","M86.9","E10.622","J20.9","Z46.81","E10.42","L60.2","Z00.00","R07.9","G47.30","Z68.41","M79.604","I82.411","I45.10","M25.511","L03.031","J02.9","M79.671","E11.329","H40.033","M79.89","E10.649","M19.071","R60.0"],"date":["2021-06-22","2021-06-22","2021-08-24","2021-11-16","2021-08-17","2021-11-16","2020-11-03","2021-02-16","2020-11-03","2021-08-17","2021-07-13","2021-08-24","2021-11-16","2021-08-24","2021-08-24","2021-08-24","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-07-13","2021-07-13","2021-08-03","2021-07-13","2021-11-02","2021-11-23","2021-11-16","2021-01-19","2021-01-19","2021-11-18","2021-11-18","2021-03-09","2021-06-22","2021-11-16","2021-11-16","2021-08-24","2021-11-23","2021-11-16","2021-05-11","2021-12-16","2021-01-26","2021-01-19","2021-08-03","2021-08-03","2020-06-02","2020-10-06","2021-03-16","2020-11-10","2020-09-29","2020-09-29","2021-03-09","2020-04-09","2021-01-26","2021-08-24","2020-09-15","2021-08-03","2021-08-03","2021-06-29","2021-06-29","2021-08-24","2021-06-29","2020-11-03","2020-11-10","2020-09-01","2020-09-01","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2021-06-22","2020-03-03","2021-03-16","2021-08-10","2021-08-10","2020-02-04","2020-08-04","2021-02-02","2021-02-02","2021-06-29","2021-08-03","2021-08-24","2021-06-22"],"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":[["","68462043790","OLMESARTAN","MEDOXOMIL20MGTAB","90","Select","Select",""],["","54040013","DESVENLAFAXINE","SUCCNTER50MG","90","Select","Select",""],["","57664050658","METOPROLOL","TARTRATE25MGTAB","60","Select","Select",""],["","143980305","DOXYCYCLINE","HYCLATE100MGCAP","14","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","10","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","14","Select","Select",""],["","80777027398","MODERNA","COVID-19VACCINE(EUA)","0.2","Select","Select",""],["","69452014330","BENZONATATE","100MGCAPSULE","30","Select","Select",""],["","456141030","BYSTOLIC","10MGTABLET","90","Select","Select",""],["","57237016999","ROSUVASTATIN","CALCIUM10MGTAB","90","Select","Select",""],["","3089421","ELIQUIS","5MGTABLET","60","Select","Select",""],["","68180016013","AZITHROMYCIN","250MGTABLET","6","Select","Select",""],["","60505025202","TIZANIDINE","HCL4MGTABLET","30","Select","Select",""],["","169750111","NOVOLOG","100UNIT\/MLVIAL","110","Select","Select",""],["","45802008801","ALBUTEROL","HFA90MCGINHALER","8.5","Select","Select",""],["","406012405","HYDROCODONE-ACETAMIN","7.5-325","7","Select","Select",""],["","8627005303","DEXCOM","G6SENSOR","3","Select","Select",""],["","65862018501","CLINDAMYCIN","HCL150MGCAPSULE","28","Select","Select",""],["","143992801","CIPROFLOXACIN","HCL500MGTAB","20","Select","Select",""],["","69315011610","FUROSEMIDE","20MGTABLET","30","Select","Select",""],["","2772801","LYUMJEV","100UNIT\/MLVIAL","20","Select","Select",""],["","67877021620","CEFUROXIME","AXETIL500MGTAB","6","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":""}]}]}