{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jill Bailey","gend":1,"currentgend":"","add":"276 Cedar Hollow Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"1980-01-23","age":"","mstatus":"","insh":"0000304368002","cliId":"","pno":4048897008,"cno":4048897008,"email":"williambailey1@cheechytees.com","ename":"","eno":"","pphy":"Kuang Chang","ppno":7063532990,"pcpadd":"3320 OLD JEFFERSON RD BLDG 800","pcpcity":"ATHENS","pcpstate":"GA","pcpzip":30607,"pcpcounty":"","pcpid":"","pcpname":"3320 OLD JEFFERSON RD BLDG 800","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"276 Cedar Hollow Rd","madd2":"","madd3":"","mcity":"Cleveland","mstate":"GA","mzip":30528,"pcpfaxno":7063532992,"pcpnpi":1952567505,"currentgendcomment":"","pphycomment":"","uniqueid":221678,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E06.3","D3A.8","F41.9","Q67.6","Z79.899","Z79.890","Z87.891","C7A.8","C7B.8","E87.20","I48.19","I47.19","Z90.49","C78.6","Z12.31","I47.10","E34.00","I49.3","R00.1","F41.1","J45.20","E66.3","Z68.27","Z13.31","C7A.012","R55","I49.9","Z00.00","E03.9","E55.9","Z68.24","R35.0","C7A.021","E34.0","I48.91","R19.7","R42","R30.0","R00.2","R00.0","I34.0","I36.1","Z68.25","C7A.1","Z11.59","E78.5","Z68.22","Z68.23","E34.9","N13.1","R94.39","Z13.29","R68.89","Z99.89","R79.89","N20.0","R07.9","I48.0","R05.9","R53.1","R31.29","Z51.5","D35.00","R94.31","R79.1","I51.7"],"date":["2026-01-05","2026-02-27","2023-07-06","2023-07-06","2025-02-25","2023-07-06","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2025-02-27","2025-02-25","2025-02-25","2024-06-07","2024-04-01","2025-06-02","2026-01-05","2024-08-20","2025-07-03","2026-01-05","2025-07-03","2026-01-05","2026-01-05","2025-07-03","2024-06-07","2024-07-19","2024-07-10","2025-01-21","2025-07-03","2025-01-21","2025-01-21","2025-01-21","2024-07-09","2024-07-18","2025-02-27","2024-07-11","2024-07-10","2025-04-16","2023-07-06","2023-07-06","2024-07-10","2024-07-10","2025-04-16","2025-07-11","2024-07-18","2024-07-18","2024-07-18","2024-10-18","2023-03-06","2025-01-29","2024-07-10","2024-03-01","2024-07-09","2024-07-09","2023-07-05","2025-01-29","2024-07-11","2024-07-10","2024-05-16","2024-07-09","2024-11-19","2024-02-05","2023-07-05","2023-07-05","2024-07-10","2023-07-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","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":[]}]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","Armour Thyroid","60 MG","","Select","Select",""],["","","Tamsulosin Hydrochloride","0.4 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Amiodarone Hydrochloride","200 MG","","Select","Select",""],["","","Octreotide","0.2 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Albuterol Sulfate Hfa","","","Select","Select",""],["","","Dexamethasone","0.5 MG","","Select","Select",""],["","","Everolimus","7.5 MG","","Select","Select",""],["","","Sandostatin Lar Depot","30 MG","","Select","Select",""],["","","Metoprolol Tartrate","25 MG","","Select","Select",""],["","","Azithromycin","500 MG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of 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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":""}]}]}