{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kimberly S Brown","gend":1,"add":"342 Forest Drive","city":"Chatsworth","state":"GA","zip":30705,"dob":"1962-03-25","age":"","mstatus":"","insh":"AS1004578001","cliId":"","pno":7064633481,"cno":"","email":"smedleybrown@windstream.net","ename":"","eno":"","pphy":"JAMES ZUPPA","ppno":"","pcpadd":"102 N Oaks Dr","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":["M18.11","D04.72","I10","E78.5","K90.9","R53.83","R79.89","Z79.899","K21.9","Z12.11","I87.309","R42","L71.0","Z87.2","Z09","D48.5","L82.1","D22.5","L57.0","L23.89","Z08","Z86.03","Z85.828","Z12.31","Z85.820","E66.3","Z68.24","L03.319","M18.12","M19.042","Z01.419","Z12.39","Z13.31","Z79.890","Z13.820","R92.8","L90.5","E87.6","L01.01","B00.89","C44.41","D04.62","M19.041","D23.62","D04.5","N63.10"],"date":["2021-11-23","2022-01-04","2021-11-16","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-04-20","2021-04-20","2021-12-14","2021-12-14","2021-12-28","2021-12-28","2021-12-28","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-05-04","2021-02-02","2021-02-02","2021-02-02","2021-08-10","2021-03-30","2021-02-02","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-02-16","2022-01-04","2021-11-23","2021-08-03","2021-08-03","2021-08-03","2021-04-27","2021-12-16","2021-05-11","2021-05-04","2021-08-24"],"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":[["","68180012202","CEPHALEXIN","500MGCAPSULE","30","Select","Select",""],["","68462025501","ROPINIROLE","HCL1MGTABLET","30","Select","Select",""],["","46110511","PREMPRO","0.3MG-1.5MGTABLET","28","Select","Select",""],["","68462049833","ZOLMITRIPTAN","5MGTABLET","6","Select","Select",""],["","93005805","TRAMADOL","HCL50MGTABLET","12","Select","Select",""],["","50816002503","METOPROLOL","SUCCER25MGTAB","30","Select","Select",""],["","16729044416","BUPROPION","HCLXL300MGTABLET","30","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","6","Select","Select",""],["","57237000205","HYDROCHLOROTHIAZIDE","12.5MGCP","30","Select","Select",""],["","45802090096","CLINDAMYCIN","PH0.01GEL","60","Select","Select",""],["","69238110005","DOXYCYCLINE","HYCLATE100MGCAP","60","Select","Select",""],["","45802006435","TRIAMCINOLONE","0.001CREAM","30","Select","Select",""],["","68462018022","MUPIROCIN","0.02OINTMENT","22","Select","Select",""],["","57237004390","VALACYCLOVIR","HCL1GRAMTABLET","8","Select","Select",""],["","406012301","HYDROCODONE-ACETAMIN","5-325MG","20","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":""}]}]}