{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kailin Skinner","gend":1,"add":"6080 LAKEVIEW  RD","city":"WARNER ROBINS","state":"GA","zip":31088,"dob":"2000-02-17","age":"","mstatus":"","insh":"AM1059129001","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Jayesh Patel","ppno":"","pcpadd":"1945 Lake Pointe Drive,N","pcpcity":"Lewisville","pcpstate":"TX","pcpzip":"","pcpcounty":"Lewisville","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"APT 106","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":["J01.01","R53.82","E16.2","R73.09","Z01.411","Z30.09","N92.6","R10.2","N83.201","Z11.3","Z11.8","E55.9","B34.9","Z20.828","J02.9","J02.0","Z71.3","E78.5","F41.8","M79.642","X58.XXX","N30.00"],"date":["2021-04-20","2021-09-28","2021-10-06","2021-12-28","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-28","2021-12-28","2021-12-28","2021-12-28","2021-07-27","2021-10-06","2021-08-17","2021-03-09","2021-08-05","2021-08-05","2021-05-18"],"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":[["","781183120","AMOX-CLAV","500-125MGTABLET","30","Select","Select",""],["","51672137001","MUPIROCIN","0.02CREAM","30","Select","Select",""],["","68462011944","FLUCONAZOLE","150MGTABLET","1","Select","Select",""],["","527293441","PREDNISONE","20MGTABLET","10","Select","Select",""],["","69543012010","ACARBOSE","25MGTABLET","90","Select","Select",""],["","65862052730","VENLAFAXINE","HCLER37.5MGCAP","30","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":""}]}]}