{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Doug Duvall","gend":0,"add":"139 Harris Ln","city":"Lafayette","state":"GA","zip":30728,"dob":"1957-05-08","age":"","mstatus":"","insh":"AS1004806001","cliId":"","pno":"(561) 248-0534","cno":"","email":"theapacherider@aol.com","ename":"","eno":"","pphy":"Matthew Chatfield","ppno":"","pcpadd":"1100 E Third St,Suite G-10","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":["C64.2","C79.51","R91.1","K76.89","R53.81","Z12.5","Z00.00","C79.89","M16.12","Z72.0","Z51.11","R22.2","C64.9","M89.9","R19.09","M25.852","N28.89","M25.552","E78.49","Z12.11","M70.62","C34.11","M17.12","G89.3","M79.89","Z91.89","C64.1","F17.210"],"date":["2022-01-06","2022-01-06","2021-11-16","2021-11-16","2022-01-06","2021-07-13","2021-07-13","2021-11-23","2021-11-09","2021-12-16","2021-11-30","2021-08-31","2021-11-23","2022-01-06","2021-11-02","2021-11-02","2021-11-02","2021-07-13","2021-07-13","2021-07-13","2021-10-26","2021-11-30","2021-08-10","2022-01-06","2021-11-23","2021-11-23","2021-11-30","2021-11-30"],"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":[["","47781023001","OXYCODONE-ACETAMINOPHEN","10-325","120","Select","Select",""],["","68462010530","ONDANSETRON","HCL4MGTABLET","9","Select","Select",""],["","54418425","DEXAMETHASONE","4MGTABLET","25","Select","Select",""],["","69015111","INLYTA","5MGTABLET","60","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":""}]}]}