{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VICKI BAKER","gend":1,"add":"2983 Rogers Drive","city":"Gainesville","state":"GA","zip":30506,"dob":"1959-11-05","age":"","mstatus":"","insh":"AM0042472001","cliId":"","pno":"","cno":"","email":"vicki.baker@aec2020.net","ename":"","eno":"","pphy":"MARGARET DAVIS","ppno":"","pcpadd":"743 Spring Street NE","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":["Z23","M54.5","K21.9","G47.00","E78.2","F41.8","E55.9","Z85.3","M05.79","Z68.27","L82.1","L43.8","L81.4","L57.0","Z51.81","H25.13","H04.123","H01.02A","H01.02B"],"date":["2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-05","2021-10-26","2021-10-26","2021-10-26","2021-10-26"],"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":[["","13668000805","ZOLPIDEM","TARTRATE10MGTABLET","30","Select","Select",""],["","13107008305","LORAZEPAM","0.5MGTABLET","30","Select","Select",""],["","43547040011","CYCLOBENZAPRINE","10MGTABLET","45","Select","Select",""],["","70377000712","ROSUVASTATIN","CALCIUM10MGTAB","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":""}]}]}