{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Heather Hall","gend":1,"add":"101 Regency Row SW","city":"Calhoun","state":"GA","zip":30701,"dob":"1975-02-25","age":"","mstatus":"","insh":243860002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"TIMOTHY SNODGRASS","ppno":"","pcpadd":"45 College Park Dr,Suite ","pcpcity":"Ringgold","pcpstate":"GA","pcpzip":"","pcpcounty":"Ringgold","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":["F32.9","I10","Z72.0","K21.9","E53.8","R07.89","I99.9","Q25.48","Z87.891","Z01.810","I20.0","R06.02","Z68.26","Z23","R53.83","Z13.6","E03.9","I34.0","I35.1"],"date":["2020-03-12","2020-02-18","2020-02-18","2020-03-12","2020-03-12","2020-02-18","2020-03-12","2020-03-03","2020-03-03","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2021-03-23","2020-02-18","2020-01-28","2020-03-12","2020-01-28","2020-01-28"],"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":[["","16729018201","HYDROCHLOROTHIAZIDE","12.5MGTB","30","Select","Select",""],["","68180098003","LISINOPRIL","10MGTABLET","30","Select","Select",""],["","69238183007","LEVOTHYROXINE","25MCGTABLET","30","Select","Select",""],["","50458057930","XARELTO","20MGTABLET","30","Select","Select",""],["","42858010250","OXYCODONE-ACETAMINOPHEN","5-325","18","Select","Select",""],["","69046903","CHANTIX","1MGCONTMONTHBOX","56","Select","Select",""],["","93314705","CEPHALEXIN","500MGCAPSULE","30","Select","Select",""],["","378034505","DIAZEPAM","5MGTABLET","30","Select","Select",""],["","10702000310","PROMETHAZINE","25MGTABLET","18","Select","Select",""],["","65162062711","TRAMADOL","HCL50MGTABLET","25","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":""}]}]}