{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard Warren","gend":0,"add":"1260 Crooked Creek Rd","city":"Eatonton","state":"GA","zip":31024,"dob":"1959-10-03","age":"","mstatus":"","insh":4508893001,"cliId":"","pno":4782517590,"cno":"","email":"rawfire1@gmail.com","ename":"","eno":"","pphy":"Eddie Richardson","ppno":"","pcpadd":"114 Harmony Crossing,Suite ","pcpcity":"Eatonton","pcpstate":"GA","pcpzip":"","pcpcounty":"Eatonton","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":["E89.0","Z68.39","Z11.4","Z11.59","M54.5","R53.83","Z79.899","M51.36","D09.3","M41.86","M48.061","M54.16","M96.1","E66.09","Z68.37","R30.9","Z01.818","Z13.220","T16.2XX","Z68.38","H60.592","E66.3","Z79.891","H60.543","G89.4","M54.02","H92.02","E03.9","M43.16","Z98.1","M47.816","M19.90"],"date":["2021-11-18","2021-11-18","2021-05-18","2021-05-18","2021-10-06","2021-11-18","2021-11-09","2021-11-18","2021-11-18","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2021-08-05","2021-08-24","2021-11-18","2021-11-18","2021-10-26","2021-10-20","2021-10-06","2021-12-08","2021-11-18","2021-09-07","2021-04-27","2021-10-26","2021-03-09","2021-02-16","2021-02-16","2021-02-23","2021-09-07"],"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":[]},{"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":""}]}]}