{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christopher Ensley","gend":0,"currentgend":"","add":"27 Gindorff Hill Rd","city":"Cherry Log","state":"GA","zip":30522,"dob":"1972-03-15","age":"","mstatus":"","insh":"0005954440002","cliId":"","pno":7062641665,"cno":7062641665,"email":"","ename":"","eno":"","pphy":"Elias Issa","ppno":7069644210,"pcpadd":"101 RIVERSTONE VIS STE 207","pcpcity":"BLUE RIDGE","pcpstate":"GA","pcpzip":30513,"pcpcounty":"","pcpid":"","pcpname":"101 RIVERSTONE VIS STE 207","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"27 Gindorff Hill Rd","madd2":"","madd3":"","mcity":"Cherry Log","mstate":"GA","mzip":30522,"pcpfaxno":7069644251,"pcpnpi":1053305888,"currentgendcomment":"","pphycomment":"","uniqueid":379383,"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":["M19.022","M19.021","M25.521","M25.522","R07.89","I10","M19.011","M16.11","E78.2","R06.02","R60.0","J44.9","E05.90","E66.813","E66.01","Z68.41","F41.9","Z12.5","Z79.899","R06.00","R07.2","R22.31","M25.561","M25.562","J40","R00.0","Z11.59","D12.3","M70.30","E55.9","R73.9","D51.9","I82.409","U07.1","R06.09","G47.33","K21.9","E83.52","R25.2","B37.0","F51.01","F41.1","R94.39","E07.9","Z20.822","R09.89","K76.0","M13.0","M10.09","M05.79","R22.40","M79.606","E66.9","J44.89","E78.5","Z86.73","Z86.718","Z87.891","Z79.82","Z79.01","R63.5","J42","G47.30","R91.8","R60.9","M25.50","R19.5","K59.09","R12","I11.9","D75.1","R06.83","Z28.310","M65.972","S90.32X","S90.02X","S96.912","M72.2","M77.32","Z12.11","E78.00","Z87.442","Z90.49","K13.0","J45.909","R63.8","Z71.6","R26.2","M79.672","M62.81","M70.21","D22.5","L82.1","L57.0","D49.2","L91.8","J44.1","R09.81","R05.1","E53.8","R07.9","J45.30","Z12.12","R53.83","E03.9","E27.40","E04.2","J10.1","K63.5","L98.9","R05.9","F17.210"],"date":["2025-10-31","2025-10-31","2025-10-31","2025-10-31","2024-11-08","2025-10-08","2025-02-13","2025-02-13","2025-11-05","2025-09-10","2025-02-17","2025-10-16","2025-11-24","2026-02-26","2025-02-17","2025-09-10","2025-10-08","2025-04-14","2026-02-26","2025-05-06","2024-12-13","2023-03-13","2025-07-11","2025-07-11","2025-02-05","2024-10-16","2024-07-26","2025-08-25","2023-03-16","2025-10-08","2023-07-18","2023-07-18","2024-09-03","2024-09-03","2025-11-20","2025-12-19","2025-04-23","2025-10-01","2025-10-01","2026-02-26","2026-02-26","2026-02-26","2025-01-29","2025-06-25","2023-01-06","2024-11-08","2025-10-08","2025-07-11","2025-07-11","2025-07-11","2024-11-08","2024-11-08","2025-06-25","2025-01-29","2025-01-29","2024-11-08","2025-07-14","2025-12-19","2025-01-29","2025-07-14","2025-05-30","2025-02-20","2025-03-17","2025-04-22","2024-11-21","2024-12-19","2025-08-25","2025-07-14","2025-07-14","2025-05-19","2024-09-03","2024-04-24","2023-03-13","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2023-05-11","2023-05-11","2025-08-25","2023-11-25","2023-11-25","2023-11-25","2025-10-16","2025-12-19","2025-12-19","2025-01-08","2025-03-10","2025-03-10","2025-03-10","2023-03-30","2025-09-16","2025-09-16","2025-09-16","2025-09-16","2025-09-16","2025-12-23","2025-12-23","2025-12-23","2025-10-08","2025-01-29","2025-10-07","2025-06-22","2025-06-25","2025-06-25","2025-06-25","2025-06-25","2023-11-25","2025-08-25","2025-09-16","2023-11-25","2025-05-06"],"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":[["","","Methimazole","5 MG","","Select","Select",""],["","","Eliquis","5 MG","","Select","Select",""],["","","Fenofibrate","120 MG","","Select","Select",""],["","","24 Hr Venlafaxine","150 MG","","Select","Select",""],["","","Rosuvastatin Calcium","20 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Potassium Chloride","20 MEQ","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Venlafaxine","100 MG","","Select","Select",""],["","","Losartan Potassium","50 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Benzonatate","100 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Trelegy Ellipta","","","Select","Select",""],["","","Dexlansoprazole","60 MG","","Select","Select",""],["","","Budesonide","","","Select","Select",""],["","","Dexamethasone","","","Select","Select",""],["","","Polyethylene Glycol 3350","240000 MG","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Triamcinolone Acetonide","0.001 MG","","Select","Select",""],["","","12 Hr Bupropion Hydrochloride","200 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Buspirone Hydrochloride","10 MG","","Select","Select",""],["","","Flowflex Covid-19 Ag Home Test","","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Ipratropium Bromide","0.021 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Anoro Ellipta 62.5-25 Mcg Inh","","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Breztri Aerosphere","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Fluconazole","150 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":""}]}]}