{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Emma Soto","gend":1,"add":"2589 Ridge Rd SE","city":"Dalton","state":"GA","zip":30721,"dob":"2007-12-19","age":"","mstatus":"","insh":"AS1004513003","cliId":"","pno":"(706) 581-6522","cno":"","email":"mkcochran311@gmail.com","ename":"","eno":"","pphy":"Rami Azzouz","ppno":"","pcpadd":"2918 E Walnut Ave","pcpcity":"Dalton","pcpstate":"GA","pcpzip":"","pcpcounty":"Dalton","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":["Z00.121","Z71.89","Z71.3","Z68.54","Z71.6","Z01.10","Z13.0","Z13.220","Z13.1","Z23","F41.9","F43.23","T14.91X","Z20.822","E03.9","T39.1X1","Z88.0","Z88.2","Z88.1","T50.992","R10.10","T39.1X2","Y92.9","F33.9","R40.0","T42.4X2","F33.2","Z20.828"],"date":["2021-04-06","2021-04-06","2021-04-06","2021-12-21","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-12-21","2021-04-06","2021-11-23","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2021-12-21","2021-12-21","2021-11-09","2021-11-09","2021-12-21","2021-11-23","2021-12-28","2021-12-28","2021-10-20"],"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":[["","16729020201","BUSPIRONE","HCL10MGTABLET","60","Select","Select",""],["","68180061207","QUETIAPINE","ER50MGTABLET","30","Select","Select",""],["","50111064801","FLUOXETINE","HCL20MGCAPSULE","30","Select","Select",""],["","42806015905","HYDROXYZINE","HCL10MGTABLET","90","Select","Select",""],["","69238153106","LARISSIA-28","TABLET","28","Select","Select",""],["","66993068130","OLANZAPINE","5MGTABLET","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":""}]}]}