{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ellen Diamond","gend":1,"add":"169 Concorde Dr","city":"Villa Rica","state":"GA","zip":30180,"dob":"1957-10-03","age":"","mstatus":"","insh":4145390001,"cliId":"","pno":6784629663,"cno":"","email":"ellendiamond123@gmail.com","ename":"","eno":"","pphy":"ERICA EDWARDS","ppno":"","pcpadd":"1790 Mulkey Rd,Suite 1","pcpcity":"Austell","pcpstate":"GA","pcpzip":"","pcpcounty":"Austell","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":["M72.2","M79.672","M79.671","M25.511","M75.121","M75.51","M19.011","M75.101","Z12.31","Z20.822","Z00.01","E66.9","Z71.3"],"date":["2021-09-21","2021-09-21","2021-09-21","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-02-11","2021-09-01","2021-04-06","2021-07-20","2021-07-20","2021-07-20"],"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":[["","378427577","VALACYCLOVIR","HCL500MGTABLET","30","Select","Select",""],["","63304001860","RANOLAZINE","ER1000MGTABLET","60","Select","Select",""],["","68180072103","AMLODIPINE","BESYLATE10MGTAB","17","Select","Select",""],["","43547035611","LISINOPRIL","40MGTABLET","30","Select","Select",""],["","93719801","FLUOXETINE","HCL40MGCAPSULE","30","Select","Select",""],["","55111012405","ATORVASTATIN","80MGTABLET","30","Select","Select",""],["","16571020150","DICLOFENAC","SODEC75MGTAB","60","Select","Select",""],["","65862086001","FAMOTIDINE","40MGTABLET","30","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""],["","70461032103","FLUCELVAX","QUAD2021-2022SYR","0.5","Select","Select",""],["","64380080707","IBUPROFEN","800MGTABLET","90","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":""}]}]}