{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Austin Tapp","gend":0,"currentgend":"","add":"4497 Trion Teloga Rd","city":"Summerville","state":"GA","zip":30747,"dob":"1998-10-29","age":"","mstatus":"","insh":"AS9033443001","cliId":"","pno":7069362665,"cno":7069362665,"email":"austinsta@windstream.net","ename":"","eno":"","pphy":"Asif Shah","ppno":2292288575,"pcpadd":"501 REDMOND RD NW","pcpcity":"ROME","pcpstate":"GA","pcpzip":30165,"pcpcounty":"","pcpid":"","pcpname":"501 REDMOND RD NW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"4497 Trion Teloga Rd","madd2":"","madd3":"","mcity":"Summerville","mstate":"GA","mzip":30747,"pcpfaxno":"","pcpnpi":1144479726,"currentgendcomment":"","pphycomment":"","uniqueid":464491,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M20.11","I10","G71.01","J98.4","K21.9","Z79.899","Z88.4","R10.32","Z13.6","R00.0","I51.89","F90.9","Z68.1","G43.709","R63.6","Z79.620","Z88.8","Z80.7","Z82.49","Z82.0","I51.9","Z01.810","I34.0","M79.671","K56.609","M25.70","G70.89","J99","Z23","Z01.818","G71.09","G43.909","I15.9","I08.1","K56.600","I50.1","G71.00","K56.699"],"date":["2025-10-02","2025-08-25","2025-10-17","2025-08-25","2026-01-30","2025-08-25","2025-08-25","2025-04-08","2025-09-25","2026-01-30","2025-09-15","2026-01-30","2025-04-08","2025-04-08","2025-04-10","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-09-15","2025-08-20","2025-08-20","2025-10-02","2025-04-25","2025-04-25","2025-10-17","2025-10-17","2025-09-25","2025-08-18","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2025-04-10","2025-04-10","2025-04-10","2025-04-08"],"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":[["","","24 Hr Amphetamine Aspartate","5 MG","","Select","Select",""],["","","Oxycodone\/Acetaminophen","","","Select","Select",""],["","","Omeprazole","","","Select","Select",""],["","","Omeprazole Dr","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Promethazine Hydrochloride","25 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":""}]}]}