{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robin Horseman","gend":1,"add":"1554 Carl Wood Rd","city":"Rocky Face","state":"GA","zip":30740,"dob":"1963-04-07","age":"","mstatus":"","insh":2099860002,"cliId":"","pno":7065374700,"cno":"","email":"","ename":"","eno":"","pphy":"Leland Duddleston","ppno":"","pcpadd":"1000 Riverburch Pkwy","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":["R05.9","G24.9","Z01.419","Z13.31","Z12.39","N95.1","U07.1","Z20.822","R50.9","R50.2","Z23","G24.8","H90.3","G56.03","R00.2","M84.374","R25.2","G93.89","R90.89","S99.921","Z86.16","R05.1","R53.81","J30.9","K76.89","D18.03","Z20.828","Z71.89","G81.11"],"date":["2021-11-23","2021-08-17","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-02-23","2021-07-06","2020-06-16","2020-06-16","2020-06-16","2020-05-12","2021-08-05","2021-08-17","2021-08-17","2020-05-26","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2020-06-23","2020-06-23","2020-12-22","2020-12-22","2020-04-14"],"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":[["","46110811","PREMPRO","0.625-5MGTABLET","28","Select","Select",""],["","23392102","BOTOX","200UNITVIAL","2","Select","Select",""],["","49281042150","FLUZONE","QUAD2021-2022SYRINGE","0.5","Select","Select",""],["","16714040102","CEFUROXIME","AXETIL500MGTAB","14","Select","Select",""],["","70954021210","TRIHEXYPHENIDYL","2MGTABLET","120","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":""}]}]}