{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Irma Nunez Carrillo","gend":1,"currentgend":"","add":"308 Fernwood Ave","city":"Dalton","state":"GA","zip":30721,"dob":"1974-08-05","age":"","mstatus":"","insh":"0007096943001","cliId":"","pno":7065797720,"cno":7065797720,"email":"ermanunez1974@icloud.com","ename":"","eno":"","pphy":"Adela Castro Gutierrez","ppno":9015457259,"pcpadd":"1107 MEMORIAL DR STE 100","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"1107 MEMORIAL DR STE 100","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"308 Fernwood Ave","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":30721,"pcpfaxno":9015159286,"pcpnpi":1013368430,"currentgendcomment":"","pphycomment":"","uniqueid":413565,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","I10","E78.5","Z23","M32.10","E66.3","Z00.00","Z12.4","R80.9","N76.0","M51.26","M54.17","H10.45","M51.16","M48.061","M54.50","M32.12","M15.9","M79.7","G89.4","Z79.899","M54.16","M54.59","M79.604"],"date":["2025-01-02","2025-01-02","2025-01-02","2024-09-18","2025-01-02","2025-01-02","2024-03-19","2024-03-19","2024-06-19","2024-06-19","2026-02-16","2026-02-16","2025-11-05","2026-01-26","2026-01-26","2026-01-26","2024-06-19","2024-06-19","2024-02-26","2024-06-19","2024-06-19","2026-02-23","2026-02-23","2026-02-23"],"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":[["","","Atorvastatin","20 MG","","Select","Select",""],["","","Farxiga","10 MG","","Select","Select",""],["","","Januvia","100 MG","","Select","Select",""],["","","Metformin Hydrochloride","500 MG","","Select","Select",""],["","","Duloxetine","30 MG","","Select","Select",""],["","","Losartan Potassium","50 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Ibuprofen","600 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Toujeo Solostar","","","Select","Select",""],["","","Erythromycin","0.005 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Hydroxychloroquine Sulfate","200 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Dexamethasone","1 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 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":""}]}]}