{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Zuleide Gomes De Luca","gend":1,"currentgend":"","add":"87 Fox Creek Dr","city":"Braselton","state":"GA","zip":"30517","dob":"1963-09-30","age":"","mstatus":"","insh":"0009051037001","cliId":"","pno":"4702652254","cno":"","email":"","ename":"","eno":"","pphy":"Shane Geffe","ppno":"2393432551","pcpadd":"3711 VILLAGE WAY STE A","pcpcity":"BRASELTON","pcpstate":"GA","pcpzip":"30517","pcpcounty":"","pcpid":"","pcpname":"3711 VILLAGE WAY STE A","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"87 Fox Creek Dr","madd2":"","madd3":"","mcity":"Braselton","mstate":"GA","mzip":"30517","pcpfaxno":"","pcpnpi":"1568091197","currentgendcomment":"","pphycomment":"","uniqueid":"488339","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":["M65.331","M79.644","R30.0","R35.0","N30.01","I10","E03.8","E78.2","Z86.73","R53.83","E53.8","E56.8","R21","M25.562","R12","M54.31","R03.0","J20.8","I63.9","M54.2","R63.8","Z13.6","Z68.27","L23.9"],"date":["2026-05-16","2026-05-16","2026-01-27","2026-01-27","2026-07-09","2026-04-07","2026-04-07","2026-04-07","2026-04-07","2026-04-07","2026-04-07","2026-04-07","2026-07-27","2026-07-09","2026-06-23","2026-06-23","2026-07-27","2026-01-06","2026-01-21","2026-01-21","2026-01-21","2026-01-21","2026-01-21","2026-07-27"],"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":[["","","PREDNISONE","20000 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","20000 MG","","Select","Select",""],["","","CEPHALEXIN","500000 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","25000 MCG","","Select","Select",""],["","","CLOPIDOGREL","75000 MG","","Select","Select",""],["","","CLOTRIMAZOLE\/BETAMETHASONE DIPROPIONATE","0","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4000 MG","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","100 %","","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":""}]}]}