{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bobby Norris","gend":0,"currentgend":"","add":"111 Ridgeview Pkwy","city":"Bowdon","state":"GA","zip":30108,"dob":"1973-07-08","age":"","mstatus":"","insh":"0009037024001","cliId":"","pno":4705264194,"cno":4705264194,"email":"norrisbobby79@gmail.com","ename":"","eno":"","pphy":"Khalil Sharif","ppno":4704902142,"pcpadd":"705 DIXIE ST","pcpcity":"CARROLLTON","pcpstate":"GA","pcpzip":30117,"pcpcounty":"","pcpid":"","pcpname":"705 DIXIE ST","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"111 Ridgeview Pkwy","madd2":"","madd3":"","mcity":"Bowdon","mstate":"GA","mzip":30108,"pcpfaxno":"","pcpnpi":1063943801,"currentgendcomment":"","pphycomment":"","uniqueid":463704,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","I50.9","I50.43","I16.1","I25.10","I47.29","E11.9","I16.0","I21.4","I50.21","I50.82","I42.9","I47.20","F17.220","I10","I50.20","Z13.89","Z87.891","Z68.33","I50.23","N17.9","I25.5","Z91.148","Z79.84","I50.42","F17.210","Z01.818","I11.0","Z79.82","Z79.01","I31.39","E11.40","Z79.02","Z79.4","I50.31","F19.10","R79.89","I50.40","I34.0","I36.1","I08.1","R07.9"],"date":["2025-12-12","2025-12-13","2025-12-13","2025-12-13","2026-01-20","2025-12-31","2025-12-13","2025-11-26","2025-11-26","2025-11-20","2025-11-23","2025-11-23","2025-11-17","2025-12-12","2026-01-20","2026-01-20","2026-01-20","2026-01-20","2026-01-20","2025-12-13","2025-11-25","2025-12-13","2025-11-09","2025-12-12","2025-11-16","2025-11-16","2025-11-14","2025-12-12","2025-12-12","2025-12-12","2025-11-18","2025-11-17","2025-11-17","2025-11-17","2025-11-25","2025-12-13","2025-12-13","2025-11-20","2025-11-18","2025-11-18","2025-12-12","2025-11-17"],"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":[["","","Amiodarone Hydrochloride","200 MG","","Select","Select",""],["","","Aspirin Low Dose","","","Select","Select",""],["","","Carvedilol","12.5 MG","","Select","Select",""],["","","Furosemide","40 MG","","Select","Select",""],["","","Entresto","","","Select","Select",""],["","","Metformin Hydrochloride","1000 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Sacubitril\/Valsartan","","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","Farxiga","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Clopidogrel","75 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","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":""}]}]}