{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bernicia Mikealle Spain","gend":1,"currentgend":"","add":"3638 Fair St","city":"Macon","state":"GA","zip":31204,"dob":"1979-12-03","age":"","mstatus":"","insh":"0008497345001","cliId":"","pno":4782324508,"cno":"","email":"spainbernicia@gmail.com","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3638 Fair St","madd2":"","madd3":"","mcity":"Macon","mstate":"GA","mzip":31204,"pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":445495,"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":["I85.10","N17.9","R62.7","D53.9","D50.9","F17.210","N18.30","K76.82","I12.9","D69.59","E87.5","R60.9","I49.3","M62.84","F10.10","Z48.02","Z88.1","K70.30","K72.90","D69.6","I11.0","I50.9","E78.5","R79.1","K21.9","E87.8","R18.8","E43","G93.41","I10","N39.0","Z79.899","Z91.148","Z68.24","K59.00","K70.31","K70.40","G93.40","K74.69","I13.0","B96.1","K92.1","K92.0","B95.1","I25.2","Z81.1","Z82.49","Z83.3","Z88.8","I85.00","K76.6","K31.89","D64.9","K31.A19","K29.70","K92.2","D62","R51.9","Z76.82","K62.5","K76.7","F10.11","E88.09","E83.42","Z53.9","Z87.891","Z90.49","I85.11","D68.9","D63.1","Z87.440","Z91.014","K52.9","K29.50","K31.A0","Z20.822","R14.0","R42","F10.239","R17","K74.60","F10.20","R00.1","R41.82","E72.20","R79.89","R41.3","Z09","E80.6","F10.91","R01.1","K52.89","K64.4","K31.819","Z12.11","I50.30","F10.139","R06.02","R10.11","R10.84","R07.89","T18.108"],"date":["2024-11-19","2025-11-25","2024-11-19","2024-11-19","2025-11-29","2024-11-29","2026-02-17","2024-11-30","2024-11-19","2025-11-25","2024-11-30","2024-11-19","2024-11-19","2024-11-21","2025-09-12","2025-09-12","2026-02-17","2026-01-07","2024-11-29","2026-02-24","2024-11-29","2026-02-17","2024-11-29","2024-11-29","2026-02-17","2024-11-29","2024-11-20","2024-11-05","2024-11-09","2024-11-21","2026-01-07","2026-02-17","2024-11-05","2024-11-05","2024-11-18","2026-02-24","2024-11-18","2024-11-30","2024-11-21","2026-02-17","2026-01-07","2026-01-07","2026-01-07","2026-01-07","2026-02-17","2026-02-17","2026-02-17","2026-02-17","2026-01-07","2025-07-29","2026-02-17","2025-11-29","2026-02-17","2025-07-29","2026-02-17","2026-02-18","2026-02-24","2024-11-30","2026-02-17","2026-02-24","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2025-11-25","2026-02-17","2026-02-17","2026-02-17","2026-02-17","2026-02-17","2026-02-17","2026-02-17","2026-02-17","2025-07-30","2025-07-30","2025-08-31","2025-09-20","2025-09-20","2025-09-08","2024-11-21","2024-11-29","2025-09-19","2024-11-30","2024-11-19","2024-11-29","2024-11-29","2024-11-05","2026-02-24","2026-02-24","2026-02-24","2026-02-24","2026-02-19","2026-02-19","2025-11-29","2025-07-29","2025-07-29","2025-07-29","2025-11-25","2026-02-19","2026-01-07","2025-09-20","2025-11-25"],"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":[["","","Lactulose","667 MG","","Select","Select",""],["","","Rifaximin","550 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Phenobarbital","","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Furosemide","","","Select","Select",""],["","","Magnesium Sulfate","0.0277 MEQ","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Folic Acid","1 MG","","Select","Select",""],["","","Carvedilol","3.125 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":""}]}]}