{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Annette Marie Bechtold","gend":1,"currentgend":"","add":"148 Stone Cliff Trce","city":"Cleveland","state":"GA","zip":30528,"dob":"1963-05-23","age":"","mstatus":"","insh":"0006221774001","cliId":"","pno":7702967254,"cno":7702967254,"email":"abech523@gmail.com","ename":"","eno":"","pphy":"Curtis Campbell","ppno":7702199100,"pcpadd":"2578 HELEN HWY","pcpcity":"CLEVELAND","pcpstate":"GA","pcpzip":30528,"pcpcounty":"","pcpid":"","pcpname":"2578 HELEN HWY","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"148 Stone Cliff Trce","madd2":"","madd3":"","mcity":"Cleveland","mstate":"GA","mzip":30528,"pcpfaxno":"","pcpnpi":1770975278,"currentgendcomment":"","pphycomment":"","uniqueid":403415,"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":["E05.90","E04.2","C54.1","K76.0","E66.01","Z68.41","Z87.891","Z51.12","C78.02","Z68.38","R10.11","R11.2","R07.89","E04.1","M79.644","M18.0","M79.645","Z68.39","Z01.810","R91.1","E66.812","K74.02","K80.10","R03.0","G60.9","Z79.899","Z79.69","M25.562","R73.03","R68.81","G89.29","R07.9","D44.0","M65.312","H16.223","K82.8","Z01.818","Z12.11","Z12.12","M18.12","M65.311","C52","Z48.813","C53.9","Z00.00","Z13.220","Z76.89","Z45.2","R91.8","K80.00","N20.0","K80.20","R00.2","I36.1","R05.3"],"date":["2026-03-18","2026-03-18","2026-03-11","2025-05-15","2024-09-03","2026-03-11","2025-03-28","2025-03-27","2025-10-29","2025-08-06","2024-07-24","2024-06-14","2025-03-28","2025-06-19","2026-01-14","2026-01-14","2026-01-14","2025-12-29","2024-12-20","2025-10-29","2025-12-29","2024-09-03","2024-09-03","2024-04-30","2026-01-28","2025-11-20","2026-03-17","2024-05-01","2024-05-01","2024-05-08","2024-05-01","2025-03-28","2025-03-13","2024-08-23","2025-09-09","2024-08-05","2024-12-20","2025-07-09","2025-07-09","2024-01-15","2024-06-13","2024-10-29","2024-11-20","2025-07-09","2025-06-18","2025-07-02","2025-06-18","2024-12-12","2025-01-30","2024-09-03","2025-05-15","2024-08-05","2025-08-06","2025-03-19","2025-01-30"],"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":[["","","Ondansetron","8 MG","","Select","Select",""],["","","Restasis","","","Select","Select",""],["","","Meloxicam","7.5 MG","","Select","Select",""],["","","Flucelvax 2025-2026","","","Select","Select",""],["","","Methimazole","5 MG","","Select","Select",""],["","","Fluzone Trivalent 2024-25 Syrg","","","Select","Select",""],["","","Hydrocodone-Acetamin 7.5-325","","","Select","Select",""],["","","Lidocaine-Prilocaine Cream","","","Select","Select",""],["","","Metoclopramide","5 MG","","Select","Select",""],["","","Lidocaine\/Prilocaine","","","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":""}]}]}