{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Keilin Casco Flores","gend":1,"currentgend":"","add":"1222 Myrtle St SE Apto  A3","city":"Gainesville","state":"GA","zip":"30501","dob":"1991-03-19","age":"","mstatus":"","insh":"0009077793002","cliId":"","pno":"4782629170","cno":"4782629170","email":"","ename":"","eno":"","pphy":"Calixto Cornavaca Diaz","ppno":"4236198381","pcpadd":"578 S ENOTA DR NE STE C","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":"30501","pcpcounty":"","pcpid":"","pcpname":"578 S ENOTA DR NE STE C","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"1222 Myrtle St SE Apto  A3","madd2":"","madd3":"","mcity":"Gainesville","mstate":"GA","mzip":"30501","pcpfaxno":"4702908474","pcpnpi":"1326381625","currentgendcomment":"","pphycomment":"","uniqueid":"525622","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":["M54.41","G83.4","E66.812","K76.0","M51.16","G89.29","Z68.37","Z60.3","R73.03","D64.9","D35.02","E28.2","Z12.4","E05.90","N97.9","R93.89","N97.8","Z75.8","R30.0","L68.0","M48.061","M51.26","M54.16","D35.00","Z68.36","M54.50","D50.9","Z09","R53.82","L65.9","Z68.38","R30.9","R51.9","R53.83","M54.9","M54.42","M79.605","R26.2","R53.81","R29.898","R71.8","E66.01","R73.09","M54.59","R10.84","Z68.39","R31.0","M54.17","M47.817"],"date":["2026-05-07","2026-04-02","2026-04-02","2026-04-02","2026-04-02","2026-08-06","2026-05-06","2026-08-04","2026-04-02","2026-05-06","2026-08-07","2026-08-07","2026-02-17","2026-08-07","2026-08-06","2026-02-23","2026-03-16","2026-08-04","2026-05-06","2026-02-17","2026-03-31","2026-03-31","2026-03-31","2026-03-16","2026-03-20","2026-08-06","2026-08-06","2026-05-06","2026-08-04","2026-08-04","2026-08-06","2026-08-05","2026-03-20","2026-03-20","2026-03-31","2026-03-27","2026-03-27","2026-03-27","2026-03-27","2026-02-25","2026-02-20","2026-02-20","2026-08-06","2026-08-06","2026-08-04","2026-08-04","2026-08-10","2026-05-07","2026-05-07"],"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":[["","","METHOCARBAMOL","500000 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","0","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500000 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40000 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100000 MG","","Select","Select",""],["","","MELOXICAM","7500 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5000 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4000 MG","","Select","Select",""],["","","IBUPROFEN","800000 MG","","Select","Select",""],["","","GABAPENTIN","300000 MG","","Select","Select",""],["","","DEXAMETHASONE","1000 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":""}]}]}