{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sam Knight","gend":0,"add":"787 Gunns Cir","city":"Cleveland","state":"GA","zip":30528,"dob":"1967-06-05","age":"","mstatus":"","insh":1662684003,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Erum Farooqi","ppno":"","pcpadd":"1270 Friendship Rd","pcpcity":"Braselton","pcpstate":"GA","pcpzip":"","pcpcounty":"Braselton","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":["Z00.00","I10","Z12.5","Z20.822","I25.10","K21.9","E78.2","F41.9","F32.9","Z68.22","F32.A","R19.5","R19.8","Z86.010","R07.2","K57.30","R31.29","G25.81","M54.42","M54.41","G89.29","Z12.11","I50.22","Z87.891","Z68.23"],"date":["2021-12-07","2021-12-07","2021-12-07","2021-07-13","2021-06-22","2021-06-08","2021-11-23","2021-11-23","2021-06-08","2021-06-08","2021-11-23","2021-03-23","2021-02-23","2021-03-09","2021-06-29","2021-03-09","2020-12-15","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2021-02-02","2020-11-10","2020-11-10","2021-11-23"],"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":[["","67877022310","GABAPENTIN","300MGCAPSULE","60","Select","Select",""],["","68645055254","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","13668001990","VENLAFAXINE","HCLER75MGCAP","30","Select","Select",""],["","52268001201","SUPREP","BOWELPREPKIT","354","Select","Select",""],["","93505898","ATORVASTATIN","40MGTABLET","30","Select","Select",""],["","68382009205","CARVEDILOL","3.125MGTABLET","60","Select","Select",""],["","65862062405","GEMFIBROZIL","600MGTABLET","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":""}]}]}