{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Skylar Kitchen","gend":1,"add":"3456 Shoreland Dr","city":"Buford","state":"GA","zip":30518,"dob":"2000-09-24","age":"","mstatus":"","insh":3849809001,"cliId":"","pno":4704222396,"cno":"","email":"skylar.kitchen3456@gmail.com","ename":"","eno":"","pphy":"Jessica Snyder","ppno":"","pcpadd":"4919 Atlanta Hwy","pcpcity":"Flowery Branch","pcpstate":"GA","pcpzip":"","pcpcounty":"Flowery Branch","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":["J01.00","J06.9","B30.9","J01.91","F33.1","F41.9","Z00.00","Z23","Z76.89","Z71.89","F39","Z32.02","Z30.430","F32.0","F43.9","Z11.3","R41.840","Z68.29","N61.0","F33.2","Z30.011","Z30.09"],"date":["2021-02-11","2021-02-11","2021-05-18","2021-05-18","2021-11-23","2021-03-30","2020-11-17","2021-11-23","2021-11-23","2020-11-17","2021-11-23","2021-11-02","2021-11-02","2021-03-30","2021-03-30","2020-10-13","2021-11-23","2021-11-23","2021-08-03","2020-12-22","2020-09-01","2021-10-26"],"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":[["","378728353","NORETH-ESTRAD-FE","1-0.02(21)-75","28","Select","Select",""],["","93585105","ESCITALOPRAM","10MGTABLET","30","Select","Select",""],["","42571016242","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","13668004501","LAMOTRIGINE","25MGTABLET","30","Select","Select",""],["","54001825","PREDNISONE","20MGTABLET","9","Select","Select",""],["","66993060536","ETONOGESTREL-EE","VAGINALRING","1","Select","Select",""],["","80777027399","MODERNA","COVID-19VACCINE(EUA)","0.5","Select","Select",""],["","17478029010","TOBRAMYCIN","0.003EYEDROP","5","Select","Select",""],["","49483060450","IBUPROFEN","800MGTABLET","30","Select","Select",""],["","781261305","AMOXICILLIN","500MGCAPSULE","30","Select","Select",""],["","73302045601","ELLA","30MGTABLET","1","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":""}]}]}