{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michi P Wimberly","gend":1,"add":"250 Desota St NE","city":"Arlington","state":"GA","zip":39813,"dob":"1973-09-06","age":"","mstatus":"","insh":3993627001,"cliId":"","pno":2293662007,"cno":"","email":"Guccioakale34@Yahoo.com","ename":"","eno":"","pphy":"Francis Kwarteng","ppno":"","pcpadd":"2100 Palmyra Rd","pcpcity":"Albany","pcpstate":"GA","pcpzip":"","pcpcounty":"Albany","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":["E11.65","N39.0","K43.9","Z79.4","D25.9","Z79.84","Z87.440","Z79.899","N92.0","D25.1","D25.0","E11.9","K56.600","K42.0","Z01.419","Z71.2"],"date":["2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-15","2021-06-15","2021-06-15","2021-10-13","2021-10-13","2021-10-13","2021-02-02","2021-02-02"],"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":[["","406012405","HYDROCODONE-ACETAMIN","7.5-325","18","Select","Select",""],["","65862018830","ONDANSETRON","HCL8MGTABLET","10","Select","Select",""],["","143992801","CIPROFLOXACIN","HCL500MGTAB","10","Select","Select",""],["","2871501","HUMULIN","70-30VIAL","10","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","69097015915","MELOXICAM","15MGTABLET","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":""}]}]}