{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Faith Gaughan","gend":1,"currentgend":"","add":"357 Emily Cir Apt B","city":"Winder","state":"GA","zip":30680,"dob":"1962-07-16","age":"","mstatus":"","insh":"0007603529002","cliId":"","pno":6782093028,"cno":"","email":"","ename":"","eno":"","pphy":"Richard Goodjoin","ppno":7707167999,"pcpadd":"175 N BROAD ST","pcpcity":"WINDER","pcpstate":"GA","pcpzip":30680,"pcpcounty":"","pcpid":"","pcpname":"175 N BROAD ST","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"357 Emily Cir Apt B","madd2":"","madd3":"","mcity":"Winder","mstate":"GA","mzip":30680,"pcpfaxno":7707168444,"pcpnpi":1306824305,"currentgendcomment":"","pphycomment":"","uniqueid":435354,"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":["I10","E78.2","I48.3","J44.1","E56.8","G62.89","I50.32","J96.11","J96.12","I11.0","G47.33","E66.01","Z68.41","I42.0","F41.1","Z68.43","Z12.31","M25.562","K21.9","I27.81","J43.8","H50.9","R53.83","G47.61","G47.09","M25.552","I48.20","I42.8","D50.9"],"date":["2026-01-27","2026-01-27","2026-01-27","2026-01-27","2025-02-13","2025-02-13","2024-07-23","2024-07-23","2024-07-23","2024-07-23","2024-07-23","2024-07-23","2024-07-23","2025-09-30","2025-10-28","2025-09-30","2026-01-27","2024-11-25","2024-09-09","2024-09-09","2025-07-17","2024-07-29","2025-10-28","2025-10-28","2025-10-28","2024-11-25","2025-07-17","2024-11-25","2024-07-29"],"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":[["","","Losartan Potassium","25 MG","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Carvedilol","12.5 MG","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Sertraline","25 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Furosemide","40 MG","","Select","Select",""],["","","Albuterol","0.83 MG","","Select","Select",""],["","","Spiriva Respimat","","","Select","Select",""],["","","Prednisone","5 MG","","Select","Select",""],["","","Amoxicillin","500 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":""}]}]}