{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tatum Riley Hall","gend":1,"currentgend":"","add":"153 Cook Rd NW","city":"Calhoun","state":"GA","zip":30701,"dob":"2024-09-04","age":"","mstatus":"","insh":"AS9013506002","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Pablo Balboa-Marciack","ppno":7066028200,"pcpadd":"100 HOSPITAL CT","pcpcity":"CALHOUN","pcpstate":"GA","pcpzip":30701,"pcpcounty":"","pcpid":"","pcpname":"100 HOSPITAL CT","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"153 Cook Rd NW","madd2":"","madd3":"","mcity":"Calhoun","mstate":"GA","mzip":30701,"pcpfaxno":7066021354,"pcpnpi":1255357067,"currentgendcomment":"","pphycomment":"","uniqueid":442013,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["H66.006","H69.83","Z00.129","J21.9","R05.1","R09.81","Z20.828","Z23","J11.1","Z00.111","P92.8","P55.0","P05.16","Q82.6","P07.38","P59.9","P07.16","Z91.89","P05.9","R50.9","H66.002","J00","P05.10","J98.4","Z13.88","Z13.1","H66.001","B09","J21.8","H10.022","H65.196","R68.89","H92.01","L20.84","E73.9","R68.12"],"date":["2026-03-12","2026-03-12","2026-03-06","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2025-12-05","2025-12-26","2024-09-17","2024-09-15","2024-09-15","2024-09-15","2024-09-23","2024-09-04","2024-09-04","2024-10-24","2024-09-08","2024-09-08","2026-02-22","2025-10-20","2025-10-20","2024-09-08","2024-09-08","2025-09-26","2025-09-26","2026-02-10","2025-09-09","2025-12-16","2025-12-16","2026-02-22","2026-02-22","2026-02-10","2026-02-10","2024-10-24","2024-10-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"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":[["","","Amoxicillin","80 MG","","Select","Select",""],["","","Triamcinolone Acetonide","","","Select","Select",""],["","","Erythromycin","0.005 MG","","Select","Select",""],["","","Oseltamivir","6 MG","","Select","Select",""],["","","Cefdinir","50 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":""}]}]}