{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra Denise Hart","gend":1,"currentgend":"","add":"470 Pine Wood Ln","city":"Cornelia","state":"GA","zip":30531,"dob":"1962-01-18","age":"","mstatus":"","insh":"0004532447001","cliId":"","pno":7069495519,"cno":7068657666,"email":"chcainc@windstream.net","ename":"","eno":"","pphy":"Huma Sohail","ppno":7705313711,"pcpadd":"700 S ENOTA DR NE","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":30501,"pcpcounty":"","pcpid":"","pcpname":"700 S ENOTA DR NE","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"470 Pine Wood Ln","madd2":"","madd3":"","mcity":"Cornelia","mstate":"GA","mzip":30531,"pcpfaxno":7705313718,"pcpnpi":1053527275,"currentgendcomment":"","pphycomment":"","uniqueid":229875,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M06.09","Z79.899","M81.0","Z68.27","N95.0","J15.9","E11.9","M06.00","I10","N17.9","R65.20","E78.5","E86.0","E87.6","F17.210","R19.7","R09.02","I25.10","Z79.82","Z79.84","Z68.28","E78.2","E55.9","Z00.00","I65.23","R01.1","L30.9","F17.200","R69","Z12.31","A41.9","R93.1","E11.22","N18.2","J18.9","J01.00","R05.1","D72.829","Z12.11","R19.00","R53.83","M25.50","R63.8","Z78.0","Z12.4","R00.0","R94.31","I12.9","K80.20","I34.0"],"date":["2025-12-01","2025-12-01","2025-12-01","2025-12-08","2026-01-15","2025-09-28","2025-12-05","2025-12-08","2025-12-08","2025-09-28","2025-09-28","2025-09-28","2025-09-28","2025-09-28","2025-09-28","2025-09-28","2025-09-28","2025-09-28","2025-09-28","2025-09-28","2026-01-15","2025-12-05","2025-12-05","2025-05-05","2025-06-18","2025-05-05","2024-10-28","2025-12-08","2025-05-02","2026-01-10","2025-09-28","2025-09-28","2025-12-08","2025-08-05","2025-09-26","2024-12-20","2024-12-20","2025-09-26","2024-04-11","2024-04-17","2024-10-25","2025-05-05","2023-03-27","2024-05-28","2025-12-08","2025-09-26","2025-09-26","2025-06-18","2025-09-26","2025-06-18"],"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":[["","","Lisinopril","20 MG","","Select","Select",""],["","","Acetaminophen","300 MG","","Select","Select",""],["","","Hydroxychloroquine Sulfate","200 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Ibandronic Acid","150 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","5 MG","","Select","Select",""],["","","Metformin Hydrochloride","500 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Metformin Hcl","500 MG","","Select","Select",""],["","","Triamcinolone Acetonide","1 MG","","Select","Select",""],["","","Benzonatate","100 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","{11 Varenicline","0.5 MG","","Select","Select",""],["","","Betamethasone Dp 0.05% Crm","","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Azithromycin","250 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":""}]}]}