{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sharon E Kim","gend":1,"add":"635 White Oak Trl","city":"Murrayville","state":"GA","zip":30564,"dob":"1984-08-05","age":"","mstatus":"","insh":4144370002,"cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"KESHMA SAUJANI","ppno":"","pcpadd":"725 Jesse Jewell Parkway SE","pcpcity":"Gainesville","pcpstate":"GA","pcpzip":"","pcpcounty":"Gainesville","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":["N83.292","N81.10","K40.20","N81.4","D27.0","K40.90","R39.12","N84.0","J45.909","N36.8","D64.9","Z80.3","Z82.49","N92.0","N93.8","Z68.20","N92.1","Z01.419","N35.82","H04.123","H02.88A","H02.88B","H35.413","H52.7","D36.9","N83.291","G89.18","N76.0","Z01.818","N76.2","Z30.41","Z79.3","N83.201","Z12.4"],"date":["2021-03-02","2021-03-02","2021-03-02","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-05-18","2021-05-18","2021-08-10","2020-07-21","2021-08-10","2020-08-18","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2020-08-04","2020-09-29","2020-09-29","2020-08-04","2020-08-04","2020-08-04","2021-08-10","2021-08-10","2020-08-18","2021-08-10"],"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":[["","430042014","LO","LOESTRINFE44835TABLET","28","Select","Select",""],["","51672126302","NYSTATIN-TRIAMCINOLONE","CREAM","30","Select","Select",""],["","13811071910","NITROFURANTOIN","MONO-MCR100MG","10","Select","Select",""],["","406051205","OXYCODONE-ACETAMINOPHEN","5-325","25","Select","Select",""],["","51293081101","PHENAZOPYRIDINE","200MGTAB","10","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":""}]}]}