{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William Nowak","gend":0,"currentgend":"","add":"90 Double Bridges Rd","city":"Jefferson","state":"GA","zip":30549,"dob":"1963-01-06","age":"","mstatus":"","insh":"0007039391001","cliId":"","pno":7063677176,"cno":7063677176,"email":"billnga47@live.com","ename":"","eno":"","pphy":"William Grimsley","ppno":7708485400,"pcpadd":"1496 WINDER HWY STE 100","pcpcity":"JEFFERSON","pcpstate":"GA","pcpzip":30549,"pcpcounty":"","pcpid":"","pcpname":"1496 WINDER HWY STE 100","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"90 Double Bridges Rd","madd2":"","madd3":"","mcity":"Jefferson","mstate":"GA","mzip":30549,"pcpfaxno":7708485424,"pcpnpi":1730372236,"currentgendcomment":"","pphycomment":"","uniqueid":413225,"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":["I74.5","I77.1","I65.23","E04.1","I73.9","R79.89","N40.0","N52.9","I26.99","R91.1","J43.9","I10","Z68.29","Z00.00","Z23","Z13.29","E66.811","Z68.30","Z12.5","E78.5","Z12.2","Z13.228","Z76.0","Z13.0","R05.9","I82.4Y1","Z79.01"],"date":["2024-12-13","2024-12-13","2024-12-17","2024-12-13","2024-12-17","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2025-09-16","2025-09-16","2025-09-16","2025-09-16","2025-09-16","2025-09-16","2025-09-16","2025-09-16","2025-09-16","2025-04-17","2025-09-16","2026-03-11","2024-06-12","2024-06-12"],"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":[["","","Eliquis","5 MG","","Select","Select",""],["","","Tadalafil","5 MG","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","100 MG","","Select","Select",""],["","","Flucelvax Trival 2024-2025 Syr","","","Select","Select",""],["","","Comirnaty 2024-25(12Y Up) Syrg","","","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":""}]}]}