{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lauren E Womack","gend":1,"add":"24 Riverpoint Pl., Apt 407","city":"Rome","state":"GA","zip":30161,"dob":"1982-03-16","age":"","mstatus":"","insh":"AM1053573001","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Pulin Patel","ppno":"","pcpadd":"501 Redmond Rd","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":["C18.7","C78.7","C78.6","C77.2","R11.2","R10.9","G89.3","R31.9","K76.9","R59.0","M79.89","Z96.0","Z85.038","Z92.3","Z90.49","Z88.8","Z79.899","D64.9","F41.9","C79.9","Z20.822","Z51.12","R10.31","R10.32","Z51.11","R11.0","T45.1X5","K56.600","R53.81","R20.2","M54.9","Z85.048","E86.0","K76.89","E46","Z68.1","Z93.2","K56.690","E87.1","E87.6","Z98.891","L03.031","N13.30","R10.10","H10.011","R19.7","R63.4","T50.905","N13.39","R10.84","R10.11","K31.5","C18.9","K56.609","R51","T36.95X","D50.9","R50.9","N28.89","N20.0","R31.1","D50.8","N13.5","Z45.2","Z46.6","K63.89","L60.0","K52.1","K04.7","Z78.0","Z98.890","C18.4","R19.5","M54.5","N28.1","R30.9","N13.1","R10.33","R11.10","R31.0","C19","Z01.818","Z08"],"date":["2021-12-28","2021-12-28","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-28","2021-12-16","2021-12-28","2021-12-16","2021-12-16","2021-12-28","2021-12-16","2021-12-16","2021-12-07","2021-11-23","2021-11-23","2021-12-07","2021-12-28","2021-04-27","2021-05-11","2021-03-16","2021-12-28","2021-12-28","2020-08-18","2020-03-24","2020-03-24","2020-03-24","2020-08-18","2021-03-16","2021-06-01","2021-04-20","2021-04-20","2020-05-19","2021-01-06","2020-05-19","2020-06-30","2020-05-19","2020-12-15","2021-12-28","2020-12-08","2021-05-18","2021-11-02","2021-12-28","2021-09-14","2021-12-28","2021-06-08","2021-02-02","2021-02-11","2021-07-13","2020-06-30","2020-06-02","2020-06-02","2021-09-07","2020-10-06","2021-09-07","2021-04-06","2021-12-28","2021-12-28","2021-04-06","2021-02-11","2021-12-07","2021-07-27","2020-12-01","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-08-05","2021-08-05","2021-08-05","2020-09-29","2020-09-29","2021-03-23","2020-09-22","2020-09-22","2021-08-24","2020-12-01","2021-07-13","2020-03-12"],"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":[["","68001016200","PROMETHAZINE","25MGTABLET","30","Select","Select",""],["","16714046701","CAPECITABINE","150MGTABLET","28","Select","Select",""],["","59746011506","PROCHLORPERAZINE","10MGTAB","45","Select","Select",""],["","168020230","CLINDAMYCIN","PH0.01GEL","30","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","6","Select","Select",""],["","42858010401","OXYCODONE-ACETAMINOPHEN","10-325","14","Select","Select",""],["","62559043130","HYDROCORTISONE","0.025CREAM","30","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MGTABLET","7","Select","Select",""],["","143122701","DICYCLOMINE","20MGTABLET","120","Select","Select",""],["","378041510","DIPHENOXYLATE-ATROP","2.5-0.025","30","Select","Select",""],["","53746054201","POTASSIUM","CLER10MEQCAPSULE","180","Select","Select",""],["","115521116","COLESTIPOL","HCL1GMTABLET","360","Select","Select",""],["","591024005","LORAZEPAM","0.5MGTABLET","30","Select","Select",""],["","65862007701","CIPROFLOXACIN","HCL500MGTAB","14","Select","Select",""],["","68462010630","ONDANSETRON","HCL8MGTABLET","24","Select","Select",""],["","60758011910","PREDNISOLONE","AC0.01EYEDROP","10","Select","Select",""],["","45802046564","KETOCONAZOLE","0.02SHAMPOO","120","Select","Select",""],["","378647099","SCOPOLAMINE","1MG\/3DAYPATCH","10","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TMP","DSTABLET","10","Select","Select",""],["","50111033401","METRONIDAZOLE","500MGTABLET","21","Select","Select",""],["","67877056960","DRONABINOL","5MGCAPSULE","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}