{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michaela Hernandez","gend":0,"currentgend":"","add":"3311 Young Forest Dr","city":"Augusta","state":"GA","zip":30906,"dob":"1987-11-23","age":"","mstatus":"","insh":"0007254002001","cliId":"","pno":7064647180,"cno":"","email":"m.hernandez8730@gmail.com","ename":"","eno":"","pphy":"Jitendrakumar Patel","ppno":7067745795,"pcpadd":"1350 WALTON WAY","pcpcity":"AUGUSTA","pcpstate":"GA","pcpzip":30901,"pcpcounty":"","pcpid":"","pcpname":"1350 WALTON WAY","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3311 Young Forest Dr","madd2":"","madd3":"","mcity":"Augusta","mstate":"GA","mzip":30906,"pcpfaxno":7067747230,"pcpnpi":1770785727,"currentgendcomment":"","pphycomment":"","uniqueid":431476,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K52.9","K57.30","K64.8","K63.89","G47.33","E66.01","I10","E03.9","J45.909","K21.9","Z79.890","Z68.44","R56.9","H53.9","G43.009","G89.29","Z53.9","E11.65","R05.1","G43.119","F41.9","R41.89","R42","M16.0","M47.816","M79.7","L03.211","B34.9","K29.70","N63.0","E11.9","M19.90","G43.909","G47.30","Z79.4","Z79.84","Z79.1","J45.21","K76.89","L23.9","K76.0","J20.9","J45.41","Z13.5","K75.81","F43.21","R92.8","R06.02","N63.21","I08.3","R92.1","M25.551","M25.552","G93.2","G56.01","R74.8","D35.2","E03.4","E66.813","Z68.43","R07.89","N64.89","J40","H92.01","R51.9"],"date":["2024-05-09","2024-05-09","2024-05-09","2024-05-09","2024-05-09","2025-03-02","2025-03-02","2025-01-09","2025-01-09","2024-05-09","2025-01-09","2025-03-02","2025-03-14","2025-03-13","2025-04-16","2025-07-02","2025-07-02","2026-02-25","2026-02-28","2026-02-11","2026-02-11","2026-02-11","2026-02-11","2025-01-17","2026-02-24","2026-02-24","2026-02-28","2026-02-28","2024-05-09","2025-01-03","2025-03-13","2025-01-09","2025-01-09","2025-01-09","2025-01-09","2025-01-09","2025-01-09","2025-08-10","2025-03-12","2025-03-12","2025-03-12","2025-03-02","2025-03-02","2025-03-13","2025-03-06","2026-01-08","2025-04-03","2025-08-09","2025-01-03","2025-08-11","2025-04-03","2025-02-06","2025-02-06","2025-03-14","2026-02-24","2025-01-09","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2025-08-10","2025-04-03","2025-03-02","2026-01-13","2026-01-13"],"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":[["","","Lisinopril","10 MG","","Select","Select",""],["","","Albuterol","0.83 MG","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Humulin N","","","Select","Select",""],["","","24 Hr Metformin Hydrochloride","500 MG","","Select","Select",""],["","","Levothyroxine Sodium","0.025 MG","","Select","Select",""],["","","Pregabalin","75 MG","","Select","Select",""],["","","{21 Ethinyl Estradiol","0.02 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Erythromycin","500 MG","","Select","Select",""],["","","Furosemide","40 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Triamcinolone Acetonide","5 MG","","Select","Select",""],["","","Pioglitazone Hydrochloride","","","Select","Select",""],["","","Humulin R","","","Select","Select",""],["","","Humulin 70\/30","","","Select","Select",""],["","","Budesonide","0.25 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":""}]}]}