{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maria Hernandez Villanueva","gend":1,"currentgend":"","add":"3385 East Vale Cir","city":"Gainesville","state":"GA","zip":30507,"dob":"1969-07-16","age":"","mstatus":"","insh":"0007521657002","cliId":"","pno":7705607002,"cno":"","email":"","ename":"","eno":"","pphy":"Maria Alban","ppno":6783444472,"pcpadd":"520 JESSE JEWELL PKWY SE","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":30501,"pcpcounty":"","pcpid":"","pcpname":"520 JESSE JEWELL PKWY SE","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3385 East Vale Cir","madd2":"","madd3":"","mcity":"Gainesville","mstate":"GA","mzip":30507,"pcpfaxno":6783443273,"pcpnpi":1396857587,"currentgendcomment":"","pphycomment":"","uniqueid":373875,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","1","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z51.11","C25.0","T78.40X","R11.0","T45.1X5","Z79.899","C25.9","K86.89","Z13.31","E11.65","Z79.4","Z68.23","D50.8","E11.9","R00.0","E87.6","Z68.21","R53.83","Z80.9","E61.1","D50.9","K91.872","D62","I95.9","K91.870","K91.840","I10","R33.9","Z79.82","Z79.85","K76.9","E86.0","E63.8","Z90.410","E43","R11.2","R16.1","K21.9","Z90.411","Z01.818","Z68.27","T81.43X","Z68.25","R74.01","K30","E11.10","R17","R10.12","R10.13","R10.10","Z68.20","F41.1","N20.0","D70.1","R63.8","L03.032","M79.675","L60.0","Z78.9","Z68.22","Z68.26","M80.052","W19.XXX","I50.32","I48.20","F03.90","D64.9","L03.031","K44.9","M25.511","G89.18","R93.5","Z85.07","Z60.3","K31.89","D63.8","T82.898","I82.890","G89.29","K66.1","K63.89","K83.1","M62.81","Z45.1","K59.00","R76.8","C22.9","Z46.82","Z01.810","E78.1","E08.65","K65.1"],"date":["2024-10-08","2026-01-27","2024-10-08","2025-11-16","2024-10-08","2024-09-24","2026-03-18","2024-04-01","2025-10-15","2026-02-04","2026-02-04","2025-05-08","2025-10-15","2025-10-15","2024-10-08","2024-09-24","2024-09-24","2024-10-08","2024-09-24","2026-01-21","2025-02-06","2024-05-29","2024-03-27","2024-03-26","2024-03-27","2024-03-27","2026-01-21","2024-03-26","2024-03-26","2024-03-26","2026-03-11","2024-05-28","2024-04-08","2024-05-13","2024-05-02","2024-05-21","2024-03-14","2024-04-08","2024-12-11","2024-03-07","2026-02-26","2024-07-09","2026-01-21","2024-08-13","2024-08-13","2024-08-13","2024-08-13","2025-05-08","2026-02-26","2026-02-26","2024-12-11","2024-10-08","2025-11-16","2024-09-26","2024-05-13","2024-12-10","2024-12-10","2024-12-10","2024-12-10","2024-12-10","2026-01-30","2024-05-14","2024-05-14","2024-05-14","2024-05-14","2024-05-14","2024-05-14","2024-11-24","2024-07-09","2024-12-10","2024-03-26","2026-02-26","2026-02-26","2026-02-26","2024-07-09","2025-03-11","2024-02-15","2024-02-15","2024-12-10","2024-03-27","2024-03-27","2024-03-06","2024-03-06","2024-10-10","2025-11-16","2024-02-13","2026-03-11","2024-04-09","2024-02-15","2024-02-15","2024-02-22","2024-05-29"],"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":[["","","Creon Dr 36,000 Unit Capsule","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Oxycodone Hcl Ir","5 MG","","Select","Select",""],["","","Celecoxib","200 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Aspirin","81 MG","","Select","Select",""],["","","0.4 Ml Enoxaparin Sodium","100 MG","","Select","Select",""],["","","Dexcom G7 Sensor","","","Select","Select",""],["","","Potassium Cl Er","20 MEQ","","Select","Select",""],["","","Mupirocin 2% Ointment","","","Select","Select",""],["","","Farxiga","10 MG","","Select","Select",""],["","","Ulticare Pen Needles\/29G X 12.7Mm","","","Select","Select",""],["","","Metoclopramide Hydrochloride","","","Select","Select",""],["","","Sucralfate","1000 MG","","Select","Select",""],["","","Humalog Mix 50\/50 Kwikpen","","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Metoclopramide","10 MG","","Select","Select",""],["","","Amox-Clav 875-125 Mg Tablet","","","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":""}]}]}