{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raymond Brown","gend":0,"currentgend":"","add":"633 Cash Rd NE","city":"Calhoun","state":"GA","zip":30701,"dob":"1963-04-20","age":"","mstatus":"","insh":"0009037976001","cliId":"","pno":7066296478,"cno":"","email":"","ename":"","eno":"","pphy":"John Antalis","ppno":"0672780138","pcpadd":"111A LAUREL CREEK RD SE","pcpcity":"CALHOUN","pcpstate":"GA","pcpzip":30701,"pcpcounty":"","pcpid":"","pcpname":"111A LAUREL CREEK RD SE","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"633 Cash Rd NE","madd2":"","madd3":"","mcity":"Calhoun","mstate":"GA","mzip":30701,"pcpfaxno":"","pcpnpi":1265420731,"currentgendcomment":"","pphycomment":"","uniqueid":200573,"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":["E11.65","I10","E78.5","K21.9","Z23","Z13.31","G20.A2","R26.89","N20.0","G20.A1","E11.9","Z79.2","Z79.899","E11.42","N40.1","R33.8","Z79.82","Z79.84","N39.0","E66.9","M54.50","Z87.891","Z12.11","Z12.12","Z00.01"],"date":["2025-11-18","2025-12-06","2025-12-06","2025-11-18","2025-11-18","2025-11-18","2026-03-04","2026-03-20","2025-12-06","2025-12-06","2025-12-06","2025-12-06","2025-12-06","2025-09-02","2025-09-02","2025-09-02","2025-09-02","2025-09-02","2025-12-06","2025-12-06","2025-12-06","2025-12-06","2025-06-14","2025-06-14","2025-06-10"],"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":[["","","Carbidopa\/Levodopa","","","Select","Select",""],["","","Duloxetine","30 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Metformin Hydrochloride","500 MG","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Esomeprazole","20 MG","","Select","Select",""],["","","Aspirin Low Dose","","","Select","Select",""],["","","Carbidopa","25 MG","","Select","Select",""],["","","Nystatin","","","Select","Select",""],["","","8 Hr Carbidopa","61.25 MG","","Select","Select",""],["","","Furosemide","","","Select","Select",""],["","","Fluticasone Propionate","","","Select","Select",""],["","","Cephalexin","","","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":""}]}]}