{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carlos Pantoja","gend":0,"currentgend":"","add":"1075 Travis Dr","city":"Gainesville","state":"GA","zip":30501,"dob":"1967-02-28","age":"","mstatus":"","insh":"0006380007002","cliId":"","pno":4702010993,"cno":"","email":"","ename":"","eno":"","pphy":"Alexander Gluzman","ppno":7705147550,"pcpadd":"1968 PEACHTREE RD NW","pcpcity":"ATLANTA","pcpstate":"GA","pcpzip":30309,"pcpcounty":"","pcpid":"","pcpname":"1968 PEACHTREE RD NW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"1075 Travis Dr","madd2":"","madd3":"","mcity":"Gainesville","mstate":"GA","mzip":30501,"pcpfaxno":7705141390,"pcpnpi":1194900704,"currentgendcomment":"","pphycomment":"","uniqueid":398630,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z51.5","I46.2","I49.01","J69.0","J96.01","J96.02","R57.0","G93.1","E87.20","B96.1","Z99.11","B96.20","R56.9","J95.01","E87.6","G25.3","I25.10","I25.2","Z60.3","R19.7","R74.01","R33.9","D64.9","M99.00","M62.838","M62.81","Z73.89","I46.9","R27.8","Z91.81","K21.9","R13.12","R48.8","G93.41","J18.9","J96.11","J04.10","Z93.0","B96.5","E11.9","G40.909","D50.9","R60.0","I10","Z93.1","E78.2","Z98.61","Z86.74","Z79.84","Z79.82","A41.9","I21.02","L89.130","R53.81","I50.20","I49.9","I47.20","R13.19","R33.8","E78.5","I21.3","R60.9","G93.40","A41.52","A41.89","J15.0","I21.4","I95.9","J15.5","J15.211","L89.816","R31.9","B95.61","Z43.0","Z71.89","R65.20","R84.6","R40.1","R41.82","J96.21","Z79.02","R74.8","Z87.01","Z11.52","Z95.5","Z79.899","I25.5","J96.00","I25.84","S19.9XX","S09.90X","L76.22","I21.09","Z46.82","J90","Z48.813","J98.4","Z46.59","J81.1","R09.89","Z95.810","J98.11","Z13.6","J15.1","R22.33","R84.0","R84.8","R91.8","R07.9","I48.91","I44.5","R94.31","J95.09","R13.10","J12.89","E11.10","E87.29"],"date":["2025-10-09","2025-10-09","2026-01-01","2025-10-09","2026-02-10","2025-10-09","2025-10-09","2026-02-11","2025-10-09","2025-10-09","2025-10-09","2025-11-23","2026-02-08","2025-10-09","2025-10-09","2026-01-01","2026-02-11","2026-02-04","2025-10-09","2025-10-09","2025-10-09","2026-01-01","2026-01-01","2025-11-13","2025-11-13","2026-01-01","2025-11-13","2026-01-01","2026-01-01","2026-01-01","2026-02-13","2026-02-13","2025-12-09","2025-11-24","2026-02-08","2025-12-24","2026-02-04","2026-02-04","2026-02-04","2026-02-08","2026-02-05","2026-02-08","2025-12-16","2026-02-08","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2026-02-08","2025-10-01","2025-11-19","2026-01-01","2025-11-30","2025-11-30","2025-11-30","2026-01-01","2026-01-01","2026-02-08","2025-10-09","2025-12-17","2025-12-21","2025-12-22","2025-12-19","2025-10-27","2025-09-18","2025-09-18","2025-11-23","2025-11-23","2025-11-23","2025-11-23","2025-11-23","2026-02-13","2025-09-28","2026-02-06","2025-09-21","2025-10-15","2025-12-16","2026-02-13","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2025-09-30","2025-09-20","2025-10-01","2025-10-06","2025-09-29","2025-10-06","2025-10-06","2025-10-06","2025-09-24","2025-10-03","2025-09-30","2025-09-30","2025-09-30","2025-09-30","2025-09-30","2025-09-30","2025-09-30","2025-10-03","2025-12-16","2025-12-24","2025-12-24","2025-09-23","2025-09-21","2026-02-04","2025-09-19","2025-09-18","2025-09-18","2025-09-18","2025-10-03","2025-09-30","2026-02-13","2025-09-19","2025-09-19"],"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":[]},{"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":""}]}]}