{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah Stanley","gend":1,"add":"1085 Boyd Rd NE","city":"Dalton","state":"GA","zip":30721,"dob":"1962-08-04","age":"","mstatus":"","insh":315240002,"cliId":"","pno":7062605498,"cno":"","email":"","ename":"","eno":"","pphy":"WESLEY STUCKEY","ppno":"","pcpadd":"1525 Chattanooga Rd","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":["Z01.419","J02.9","J20.9","R05","Z13.9","Z12.31","R92.8","R92.2","L30.9","H81.12","H60.543","H93.13","H90.3","L71.9","D22.9","D18.01","L82.1","I78.9","L85.9","L81.4","L85.3"],"date":["2020-11-24","2021-07-13","2021-07-13","2021-07-13","2020-09-29","2021-08-24","2021-08-24","2021-08-24","2021-07-13","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2020-04-21","2021-04-20"],"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":[["","781713354","ESTRADIOL","0.05MGPATCH(1\/WK)","4","Select","Select",""],["","555087202","MEDROXYPROGESTERONE","2.5MGTAB","30","Select","Select",""],["","66993096045","METRONIDAZOLE","0.0075CREAM","45","Select","Select",""],["","713070185","MOMETASONE","FUROATE0.001SOLN","30","Select","Select",""],["","21922000201","CLINDAMYCIN","PH0.01SOLUTION","60","Select","Select",""],["","45802006435","TRIAMCINOLONE","0.001CREAM","15","Select","Select",""],["","60432060416","PROMETHAZINE-DM","6.25-15MG\/5ML","100","Select","Select",""],["","50111078751","AZITHROMYCIN","250MGTABLET","6","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":""}]}]}