{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael Ralston","gend":0,"add":"468 Wheeler Dam Rd","city":"Cohutta","state":"GA","zip":30710,"dob":"1969-07-13","age":"","mstatus":"","insh":4534844001,"cliId":"","pno":4233091906,"cno":"","email":"renterprises@charter.net","ename":"","eno":"","pphy":"Michael Brit","ppno":"","pcpadd":"979 E 3rd Street,Suite B-80","pcpcity":"Chattanooga","pcpstate":"TN","pcpzip":"","pcpcounty":"Chattanooga","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":["M16.11","M16.12","G89.4","M25.511","M25.571","G63","Z79.899","Z95.5","M25.551","M25.552","C44.90","M32.9","I10","R93.6","M89.411","M75.121","M75.111","M19.071","M19.042","M19.041","R60.0","E78.5","R03.0","Z68.28","M15.9","E27.40","M25.60","M25.50","S46.212","M67.813","R07.9","Z86.79","J06.9","R05","Z68.27","M54.5","G89.29","M54.2","M19.171","E24.2","R51","M54.59","R07.89","H25.043","I25.10","I21.9","H25.042","M54.17","M54.50","E66.3","I25.110","I20.0","B36.9","H25.041","R69","I34.8","I34.1","G56.22","M47.812"],"date":["2021-04-27","2021-04-27","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2021-03-02","2020-12-22","2021-07-27","2020-06-16","2020-06-16","2020-06-30","2020-06-30","2021-02-16","2021-04-20","2021-04-20","2020-04-09","2021-07-27","2020-03-24","2020-09-08","2020-09-08","2020-04-28","2021-02-11","2021-04-20","2021-02-11","2020-05-12","2021-03-09","2021-03-09","2020-01-21","2020-01-21","2020-01-21","2021-09-14","2021-04-20","2021-04-20","2021-04-20","2020-02-18","2020-02-18","2022-01-04","2020-12-08","2020-08-04","2021-07-27","2021-02-02","2020-09-15","2022-01-04","2022-01-04","2022-01-04","2020-12-22","2020-12-22","2020-04-28","2020-09-22","2021-03-16","2021-03-30","2021-03-30","2021-02-09","2021-02-11"],"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":[["","603533815","PREDNISONE","10MGTABDOSEPACK","21","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":""}]}]}