{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Emily B Kent","gend":1,"add":"281 Galagi Na Dr","city":"Dawsonville","state":"GA","zip":30534,"dob":"1998-04-21","age":"","mstatus":"","insh":2037488001,"cliId":"","pno":7065315344,"cno":"","email":"Emilykent.ek@gmail.com","ename":"","eno":"","pphy":"BRETT WALLENTINE","ppno":"","pcpadd":"800 Oakhurst Dr","pcpcity":"Evans","pcpstate":"GA","pcpzip":"","pcpcounty":"Evans","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":["M54.6","Z79.899","L65.9","E53.8","I10","M54.89","V89.2XX","Z20.828","Z11.59","E28.2","F33.9","F41.1","Z01.419","Z68.41","J01.90","S19.9XX","Z13.89","Z71.41","Z13.31","S29.9XX"],"date":["2021-09-01","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-12-14","2021-12-14","2021-11-23","2021-11-23","2021-08-17","2021-08-17","2021-08-17","2021-09-21","2021-09-21","2021-11-09","2021-12-28","2021-06-29","2021-06-29","2021-06-29","2021-12-28"],"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":[["","65862019399","FLUOXETINE","HCL20MGCAPSULE","30","Select","Select",""],["","42806066405","BUSPIRONE","HCL15MGTABLET","60","Select","Select",""],["","52817033200","CYCLOBENZAPRINE","10MGTABLET","60","Select","Select",""],["","61442010201","DICLOFENAC","SODDR50MGTAB","60","Select","Select",""],["","70010049105","METFORMIN","HCLER500MGTABLET","30","Select","Select",""],["","65162046650","IBUPROFEN","800MGTABLET","90","Select","Select",""],["","781185220","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","406012305","HYDROCODONE-ACETAMIN","5-325MG","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":""}]}]}