{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARA A HELBERT","gend":1,"add":"538 Donahoo Rd SE","city":"Silver Creek","state":"GA","zip":30173,"dob":"1980-08-11","age":"","mstatus":"","insh":1445525001,"cliId":"","pno":7063312023,"cno":"","email":"sarahelbert80@gmail.com","ename":"","eno":"","pphy":"Wilma Briones Mull","ppno":"","pcpadd":"1328 Joe Frank Harris Parkway SE","pcpcity":"Cartersville","pcpstate":"GA","pcpzip":"","pcpcounty":"Cartersville","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":["Z01.411","R87.610","I10","Z68.30","Z71.3","Z71.89","Z00.01","E78.2","F33.0","Z12.31","E66.8","G43.009","Z13.6","H50.51","Z13.5","E34.8","R53.83","Z00.00","G43.109","E03.4","M25.561","Z23","F41.8","Z68.28","Z11.51","Z01.419","Z20.822"],"date":["2021-12-28","2020-12-08","2020-12-08","2021-12-08","2021-12-08","2021-12-08","2021-11-23","2021-12-28","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-03-09","2021-06-29","2021-06-29","2020-04-09","2020-04-09","2021-03-09","2020-11-24","2020-04-09","2021-12-08","2021-12-08","2020-03-03","2020-03-03","2021-01-19","2021-01-19","2021-09-07"],"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":[["","59746011306","PROCHLORPERAZINE","5MGTABLET","16","Select","Select",""],["","68645052254","SERTRALINE","HCL50MGTABLET","45","Select","Select",""],["","93831118","ELETRIPTAN","HBR40MGTABLET","12","Select","Select",""],["","43598065530","BUPROPION","HCLXL150MGTABLET","30","Select","Select",""],["","23650110","UBRELVY","100MGTABLET","10","Select","Select",""],["","59267100003","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","57237008863","RIZATRIPTAN","10MGTABLET","12","Select","Select",""],["","93505698","ATORVASTATIN","10MGTABLET","30","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":""}]}]}