{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tony Fernandez","gend":0,"currentgend":"","add":"175 Dennis Dr Apt 207","city":"Athens","state":"GA","zip":30605,"dob":"1961-08-22","age":"","mstatus":"","insh":"0009035944001","cliId":"","pno":7065335395,"cno":"","email":"fernandeztony479@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":"175 Dennis Dr Apt 207","madd2":"","madd3":"","mcity":"Athens","mstate":"GA","mzip":30605,"pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":467429,"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":["R06.02","Z74.3","F10.220","E44.0","D72.819","I10","D50.9","Z68.21","R74.01","R07.89","G89.29","M54.9","R29.6","R25.1","E78.5","R26.9","Z79.82","Z82.49","Z87.891","K21.00","G62.9","Z79.899","Z91.51","R74.8","I25.2","S09.90X","Z13.6","M54.2","F10.229","I49.3","R26.2","Z11.52","E87.20","K92.0","G93.89","G90.9","K76.0","Z79.01","S50.811","R51.9","M47.812","S39.012","M50.90","F10.120","R79.89","R07.9","F10.90","D64.9","Z12.11","Z11.59","I26.99","J90","R91.1","F10.129","S29.9XX","F13.10","F14.10","M54.6","M54.50","F10.10","F10.230","I65.23","R53.1","F41.9","M50.30","Z71.41","Z87.81","Z91.81","Z63.5","F10.20","I24.89","I25.3","Q21.12","R26.89","M94.0","M48.02","R09.89","S19.9XX","S39.91X","R42","R26.81","S39.93X","I21.4","I24.9","F10.939","R91.8","R55","F10.929","R74.02","Z87.39","Z86.69","R53.81","F19.10","F10.920","F10.29","M47.811","R41.82","K44.9","J47.9","E78.2","Q21.10","F10.239","R06.00","K82.8","G20.A1","F10.221","Y90.8","I5A","F10.99","F19.90","Z78.9","M47.816","M41.9"],"date":["2025-09-29","2026-02-10","2026-03-03","2025-12-25","2025-12-28","2026-03-03","2025-12-25","2025-12-25","2026-01-07","2026-03-05","2026-01-07","2025-12-28","2025-12-25","2025-12-25","2025-12-25","2025-12-25","2026-02-08","2025-12-25","2026-03-03","2025-12-25","2025-12-25","2025-12-25","2025-12-25","2026-01-07","2026-02-08","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2025-10-01","2025-10-01","2025-10-01","2025-09-03","2025-09-03","2025-10-29","2025-09-03","2025-09-03","2026-03-03","2025-09-03","2026-03-03","2026-03-03","2025-09-29","2025-09-29","2026-02-10","2026-01-03","2026-03-05","2026-02-11","2025-10-14","2025-11-21","2025-10-14","2026-01-07","2025-12-27","2026-01-07","2026-03-05","2026-03-03","2026-01-03","2026-01-07","2026-01-03","2026-01-07","2025-12-06","2025-10-29","2025-10-29","2025-10-31","2025-10-29","2025-10-29","2025-10-29","2025-10-29","2025-10-29","2025-10-29","2026-02-11","2025-08-02","2025-08-02","2025-08-02","2025-12-26","2025-08-02","2025-08-02","2025-12-06","2026-03-02","2026-03-02","2025-11-05","2025-12-28","2026-01-03","2025-12-27","2025-09-30","2025-12-28","2026-02-08","2025-12-06","2025-12-25","2025-09-05","2025-09-05","2025-09-05","2025-10-31","2026-01-03","2025-09-29","2025-10-01","2025-09-29","2025-10-30","2026-03-03","2026-03-03","2026-01-07","2025-11-21","2026-01-07","2025-10-01","2025-12-26","2025-08-02","2025-05-03","2025-05-03","2025-09-30","2025-12-26","2026-01-07","2026-01-07","2025-09-29","2025-09-29"],"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":[["","","Atorvastatin","20 MG","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Naltrexone Hydrochloride","50 MG","","Select","Select",""],["","","Eliquis Starter Pack","","","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":""}]}]}