{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna Stanley","gend":1,"currentgend":"","add":"848 Clement Rd","city":"Rocky Face","state":"GA","zip":30740,"dob":"1961-12-22","age":"","mstatus":"","insh":"0007273951001","cliId":"","pno":7065379753,"cno":"","email":"dstanley61@gmail.com","ename":"","eno":"","pphy":"GABRIEL RICH","ppno":4237786784,"pcpadd":"979 E 3RD STREET","pcpcity":"CHATTANOOGA","pcpstate":"TN","pcpzip":37403,"pcpcounty":"","pcpid":"","pcpname":"979 E 3RD STREET","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"848 Clement Rd","madd2":"","madd3":"","mcity":"Rocky Face","mstate":"GA","mzip":30740,"pcpfaxno":"","pcpnpi":1932972064,"currentgendcomment":"","pphycomment":"","uniqueid":410951,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I63.81","G81.94","M75.00","R29.2","M47.812","I69.954","M62.81","R29.898","G81.04","I63.9","G25.81","R41.3","Z86.73","E78.5","R79.89","N39.0","R31.29","R33.9","I70.90","Z80.3","M79.645","R51.9","R20.0","R53.1","R79.9","G93.89","R93.0","I69.354","R05.1","I10","J10.1","R31.9","N30.90","Z00.00","M19.071","M25.512","M19.012","S46.002","F48.2","I67.82","H74.8X9","R20.2","G43.809","R10.84","I63.89","M47.892","F32.1","G47.33","G47.09","R05.9","J02.9","J01.00","R09.81","Z12.31","M50.23","G45.9","F41.1","G47.30","Z13.31","I67.850","I49.1","R94.31","I49.8","Z13.6"],"date":["2025-05-08","2025-09-08","2025-05-08","2025-01-23","2025-01-23","2025-05-08","2025-04-30","2025-04-30","2025-04-30","2025-12-05","2025-09-08","2025-01-27","2025-09-08","2025-12-15","2025-01-16","2024-03-19","2024-03-19","2024-03-19","2024-09-03","2024-09-03","2024-09-03","2024-09-03","2024-09-03","2024-09-03","2024-09-03","2025-05-05","2025-05-05","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2024-02-26","2024-02-08","2024-02-08","2025-08-15","2025-02-27","2025-02-27","2025-02-27","2025-03-05","2024-12-23","2025-05-05","2024-09-03","2024-09-03","2024-09-03","2025-01-23","2024-12-23","2025-12-15","2025-12-15","2025-01-14","2025-11-03","2025-11-03","2025-11-03","2025-11-03","2024-03-07","2025-01-23","2024-09-27","2024-09-27","2024-09-27","2025-01-27","2026-01-29","2024-09-03","2024-09-03","2024-09-03","2024-09-03"],"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":[["","","Rosuvastatin Calcium","40 MG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Mirtazapine","30 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Pramipexole Dihydrochloride","0.25 MG","","Select","Select",""],["","","Dextromethorphan Hydrobromide","20 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Donepezil Hydrochloride","10 MG","","Select","Select",""],["","","Memantine Hydrochloride","10 MG","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","Amoxicillin","875 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":""}]}]}