{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Esmerelda Brown","gend":1,"currentgend":"","add":"2736 Nautical Way","city":"Villa Rica","state":"GA","zip":30180,"dob":"1935-07-07","age":"","mstatus":"","insh":"0008097306002","cliId":"","pno":7543326309,"cno":"","email":"tracy.walters@hotmail.com","ename":"","eno":"","pphy":"Allison Key","ppno":7705371234,"pcpadd":"107 WEDGEWOOD DR","pcpcity":"CARROLLTON","pcpstate":"GA","pcpzip":30117,"pcpcounty":"","pcpid":"","pcpname":"107 WEDGEWOOD DR","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"2736 Nautical Way","madd2":"","madd3":"","mcity":"Villa Rica","mstate":"GA","mzip":30180,"pcpfaxno":7705371235,"pcpnpi":1871781476,"currentgendcomment":"","pphycomment":"","uniqueid":430199,"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":["M25.561","M19.90","F03.90","K29.00","J00","M81.0","E55.9","J30.9","E78.2","Z87.01","Z55.6","Z91.81","M17.0","Z78.0","I10","F03.A0","R82.998","K44.9","G89.29","R05.3","J45.998","E78.5","R10.30","R55","R26.81","M81.8","Z13.1","M25.562","R05.1","Z13.31","R05.2","Z13.89","H34.831","H35.033","M85.89","N95.1"],"date":["2025-11-24","2025-05-13","2025-11-24","2025-03-25","2025-03-25","2025-03-25","2025-03-25","2025-03-25","2025-08-25","2025-03-25","2025-03-25","2025-03-25","2025-11-24","2025-10-01","2026-02-24","2026-02-24","2026-02-24","2025-04-08","2025-11-24","2025-07-07","2025-07-07","2025-11-24","2026-02-09","2026-02-09","2026-02-09","2025-11-24","2025-11-25","2025-11-24","2025-02-03","2025-02-03","2025-06-09","2025-06-09","2025-03-12","2025-03-12","2025-10-01","2025-10-01"],"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":[["","","Amlodipine","5 MG","","Select","Select",""],["","","Donepezil Hydrochloride","5 MG","","Select","Select",""],["","","Memantine Hydrochloride","5 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Benzonatate","100 MG","","Select","Select",""],["","","Wixela Inhub","","","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":""}]}]}