{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rekhaben Thakkar","gend":1,"currentgend":"","add":"163 Bay Meadows Cir","city":"Fitzgerald","state":"GA","zip":"31750","dob":"1963-07-01","age":"","mstatus":"","insh":"0009074561001","cliId":"","pno":"9124248007","cno":"9124248007","email":"","ename":"","eno":"","pphy":"Navdeepa Chainani","ppno":"2293865101","pcpadd":"72 KENT RD STE 4","pcpcity":"TIFTON","pcpstate":"GA","pcpzip":"31794","pcpcounty":"","pcpid":"","pcpname":"72 KENT RD STE 4","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"163 Bay Meadows Cir","madd2":"","madd3":"","mcity":"Fitzgerald","mstate":"GA","mzip":"31750","pcpfaxno":"2293862277","pcpnpi":"1871804641","currentgendcomment":"","pphycomment":"","uniqueid":"347378","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":["I10","R30.0","E78.49","F41.1","J01.80","B37.31","N95.1","M25.561","M15.0","K21.9","E78.1","Z68.29","Z12.31","G47.00","E11.9","E78.5"],"date":["2026-07-01","2026-04-21","2026-06-23","2026-05-26","2026-04-21","2026-04-21","2026-06-23","2026-05-26","2026-06-23","2026-07-01","2026-06-23","2026-06-23","2026-06-01","2026-05-26","2026-03-05","2026-03-05"],"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":[["","","ATORVASTATIN CALCIUM","20000 MG","","Select","Select",""],["","","OMEPRAZOLE","40000 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","25000 MG","","Select","Select",""],["","","ZOLPIDEM TARTRATE","10000 MG","","Select","Select",""],["","","FLUCONAZOLE","100000 MG","","Select","Select",""],["","","CELECOXIB","200000 MG","","Select","Select",""],["","","ONDANSETRON ODT","4000 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","25000 MG","","Select","Select",""],["","","ESTRADIOL","100 MG\/GM","","Select","Select",""],["","","ESCITALOPRAM OXALATE","20000 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40000 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":""}]}]}