{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Fatima Luna Gonzalez","gend":1,"currentgend":"","add":"170 Posten Way","city":"Dalton","state":"GA","zip":30720,"dob":"1973-08-07","age":"","mstatus":"","insh":"0009040650001","cliId":"","pno":7065379312,"cno":"","email":"","ename":"","eno":"","pphy":"Carlos Penaherrera Oviedo","ppno":7062261622,"pcpadd":"475 REED RD STE 104","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"475 REED RD STE 104","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"170 Posten Way","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":30720,"pcpfaxno":7062726445,"pcpnpi":1093268138,"currentgendcomment":"","pphycomment":"","uniqueid":472753,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S81.002","S81.802","S91.002","B45.0","E03.9","K75.4","G44.229","D53.9","Z94.4","Z86.2","D84.821","E11.622","E11.65","Z79.4","E03.8","R19.8","R19.5","L97.921","E83.42","N18.31","I10","Z23","T86.49","B45.9","D84.9","Z00.00","Z85.05","Z86.19","R30.0","T86.41","C22.0","E87.6","Z12.31","R91.8","L98.499","S81.832","L60.0","T07.XXX"],"date":["2026-01-22","2026-01-22","2026-01-22","2026-03-10","2026-03-10","2026-03-10","2026-03-10","2026-03-10","2026-03-12","2026-03-10","2026-03-12","2026-03-12","2026-01-12","2026-01-12","2026-01-08","2026-01-12","2026-01-15","2026-03-12","2025-09-04","2025-10-23","2025-10-23","2025-10-23","2025-09-04","2026-03-02","2026-03-02","2026-02-19","2026-02-19","2026-02-19","2025-09-24","2025-09-24","2025-10-03","2025-10-03","2026-02-03","2026-02-19","2026-02-13","2025-11-11","2025-12-11","2025-12-11"],"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":[["","","Fluconazole","200 MG","","Select","Select",""],["","","Aspirin Low Dose","","","Select","Select",""],["","","Levothyroxine Sodium","0.025 MG","","Select","Select",""],["","","Prednisone","5 MG","","Select","Select",""],["","","Omeprazole Dr","","","Select","Select",""],["","","Mupirocin","","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Omeprazole","","","Select","Select",""],["","","Fluticasone Propionate","0.05 MG","","Select","Select",""],["","","Tacrolimus","0.5 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":""}]}]}