{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy Gonzales","gend":1,"currentgend":"","add":"2991 Joshua Tree Ln","city":"Gainesville","state":"GA","zip":"30507","dob":"2003-07-18","age":"","mstatus":"","insh":"0009048096001","cliId":"","pno":"6782674434","cno":"","email":"","ename":"","eno":"","pphy":"Jeremiah Huang","ppno":"7708486140","pcpadd":"1439 JESSE JEWELL PKWY NE STE 202","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":"30501","pcpcounty":"","pcpid":"","pcpname":"1439 JESSE JEWELL PKWY NE STE 202","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"2991","add3":"","madd1":"2991 Joshua Tree Ln","madd2":"2991","madd3":"","mcity":"Gainesville","mstate":"GA","mzip":"30507","pcpfaxno":"","pcpnpi":"1285169722","currentgendcomment":"","pphycomment":"","uniqueid":"484228","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":["R51.9","Z3A.36","O21.8","O99.013","O99.613","K21.9","R04.0","R20.0","N83.291","R79.89","O99.213","E66.813","Z36.2","Z3A.24","O34.81","N83.202","Z3A.12","N30.01","G43.909","O23.12","Z3A.17","Z60.3","O99.612","O34.82","O99.352","Z3A.15","M54.17","G62.89","R55","O99.891","M25.562","M54.9","O21.9","Z3A.13","O20.0","Z3A.01","Z34.00","Z34.02","N89.8","R10.20","N83.201","Z28.21","Z13.79","M54.40","R53.83","Z11.3","R29.898","Z36.85","O09.893","Z3A.38","O26.893","Z68.41","Z3A.31","G43.809","R53.1","O32.1XX","Z3A.20","O99.02","Z37.0","O99.893","R42","R06.02","O26.891","Z3A.14","W19.XXX","R11.10","R00.2","R07.89","R29.90","Z3A.26","E55.9","O99.419","I99.9","Z34.90","Z3A.37","R39.9","E87.8","H53.8","Z76.89","Z68.37","O47.9","R07.9","Z3A.11","R82.81","Z34.81","O26.843","Z3A.35","O09.892","O99.212","M54.42","E66.812","O26.892","Z68.35","N94.89","O99.019","O47.03","Z68.39","N93.0","N30.00","R10.23","N83.292","O09.891","R39.89","O99.211","R12","R30.0","R11.2","O99.611","O99.03","O99.215","O36.819","O62.0","Z33.1","H04.123","H01.02A","H01.02B","H52.7","Z13.1","Z36.9","I49.3","N83.299","O36.80X","R11.0","M62.838","R56.9"],"date":["2026-07-04","2026-07-04","2026-05-26","2026-07-17","2026-05-26","2026-06-09","2026-05-26","2026-07-16","2026-05-26","2026-07-16","2026-07-17","2026-07-18","2026-04-07","2026-04-07","2026-01-16","2026-01-16","2026-01-16","2026-02-20","2026-02-20","2026-02-20","2026-02-20","2026-02-20","2026-02-20","2026-02-20","2026-04-23","2026-04-23","2026-05-29","2026-05-29","2026-01-24","2026-01-24","2026-01-24","2026-01-24","2026-01-24","2026-01-24","2026-01-15","2026-01-15","2026-01-23","2026-02-17","2026-02-17","2026-02-17","2026-02-17","2026-02-17","2026-03-10","2026-02-17","2026-03-10","2026-05-06","2026-05-29","2026-07-09","2026-07-16","2026-07-17","2026-07-16","2026-07-18","2026-05-26","2026-02-17","2026-02-20","2026-03-10","2026-03-10","2026-07-17","2026-07-18","2026-05-06","2026-05-06","2026-05-06","2026-01-24","2026-01-27","2026-01-24","2026-06-30","2026-04-21","2026-05-19","2026-05-19","2026-04-21","2026-06-09","2026-03-10","2026-03-10","2026-06-30","2026-07-09","2026-01-23","2026-03-11","2026-03-10","2026-03-10","2026-08-14","2026-05-06","2026-02-17","2026-01-10","2026-01-10","2026-01-27","2026-06-25","2026-06-25","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-04-07","2026-07-04","2026-05-06","2026-05-06","2026-05-06","2026-05-06","2026-08-14","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-07-18","2026-07-18","2026-03-19","2026-07-17","2026-02-17","2026-04-01","2026-04-01","2026-04-01","2026-04-01","2026-05-06","2026-05-06","2026-04-21","2026-08-14","2026-01-23","2026-05-29","2026-05-29","2026-02-18"],"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":[["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100000 MG","","Select","Select",""],["","","METRONIDAZOLE VAGINAL","750 %","","Select","Select",""],["","","IBUPROFEN","800000 MG","","Select","Select",""],["","","ONDANSETRON ODT","8000 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","0","","Select","Select",""],["","","PROMETHAZINE HYDROCHLORIDE","25000 MG","","Select","Select",""],["","","OMEPRAZOLE DR","40000 MG","","Select","Select",""],["","","NAPROXEN","500000 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":""}]}]}