{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rosa Isela Samaniego","gend":1,"currentgend":"","add":"3590 Dogwood Point Way","city":"Gainesville","state":"GA","zip":30507,"dob":"1970-03-22","age":"","mstatus":"","insh":"0000095562001","cliId":"","pno":6789971670,"cno":6789971670,"email":"rssamaniego@aol.com","ename":"","eno":"","pphy":"Dimpu Patel","ppno":6784500202,"pcpadd":"663 LANIER PARK DR","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":30501,"pcpcounty":"","pcpid":"","pcpname":"663 LANIER PARK DR","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3590 Dogwood Point Way","madd2":"","madd3":"","mcity":"Gainesville","mstate":"GA","mzip":30507,"pcpfaxno":"","pcpnpi":1992001523,"currentgendcomment":"","pphycomment":"","uniqueid":220518,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","E55.9","Z96.652","M62.81","R29.898","R26.89","M17.11","Z12.31","A41.9","R11.2","R10.13","Z85.3","Z92.21","C50.811","N18.32","Z68.34","Z79.899","D64.9","Z17.1","K21.9","I13.10","E03.9","R20.2","E66.811","G56.23","M54.12","M79.602","M79.601","G56.21","G56.22","R07.89","G89.18","Z00.01","Z23","Z13.31","I10","E78.2","Z86.010","Z68.33","N30.91","R10.20","M54.50","Z68.36","M25.611","I89.0","E83.42","R53.83","R07.9","I70.0","Z51.11","M17.12","R80.9","Z17.22","Z17.31","Z90.11","J30.1","J30.81","Z01.419","Z12.4","R93.89","D70.1","T45.1X5","M50.13","M53.3","M47.13","N03.8","D50.8","C50.919","M47.816","M47.817","M47.896","M47.897","T78.40X","R11.0","J45.909","E66.9","R65.10","D50.9","I12.9","K22.89","K44.9","K57.30","Z90.49","Z51.12","E66.8","R19.7","M54.42","M54.41","G89.29","Z80.0","N18.31","R31.29","K64.8","E66.812","J02.9","U07.1","Z20.822","J02.0","R80.8","M17.0","M25.561","M25.562","E53.8","N95.1","J45.21","Z68.35","R06.02","H93.A2","E78.5","N18.30","J45.998","R60.1","R92.2","N17.9","D72.829","Z68.32","M15.9","J01.00","R05.1","Z68.31","K22.2","R00.2","I65.21","Z47.1","M62.830","J45.20","M47.892","S13.4XX","M54.2","M47.812","G44.86","M50.320","M48.02","N63.13","R92.0","R21","R51.9","M79.89","R22.31","M75.42","M46.1","M47.898","S33.6XX","M54.16","M51.360","M54.51","M51.17","M16.0","E86.0","R05.9","J10.1","J06.9","M79.671","M19.071","M79.672","N63.10","J45.30","J30.9","L20.89","M25.512","N89.8","N30.00","B37.31","L60.0","M72.2","R10.23","M50.30","Z86.19","I36.1","I37.1","Z13.1","Z96.651","M79.605","R07.0","J34.89","Z45.2","M62.838","M47.22","Z01.818","R00.0","M19.072","M25.572","N84.0","N17.8","Z71.89","J01.90","R73.09","N95.0","R93.3","R10.12","R92.30","N63.15","Z01.810","K31.89","K62.5","K64.9","R03.0","K92.0","R10.9"],"date":["2026-03-20","2026-03-09","2025-07-31","2024-03-28","2024-03-28","2024-03-28","2024-03-28","2023-08-04","2024-06-27","2024-06-26","2025-01-02","2025-04-16","2024-09-19","2026-01-15","2026-03-09","2025-04-09","2025-03-26","2025-02-27","2026-01-15","2025-02-27","2025-02-27","2026-02-16","2025-07-21","2025-02-27","2025-07-21","2025-08-08","2025-07-21","2026-02-22","2025-07-21","2025-07-21","2026-02-16","2023-09-28","2023-07-11","2024-12-05","2026-01-15","2026-03-20","2025-08-01","2026-01-14","2025-02-03","2025-11-11","2025-12-05","2025-12-29","2026-01-15","2025-07-25","2026-01-05","2024-10-03","2025-01-16","2024-06-26","2024-03-20","2025-04-17","2023-04-13","2026-03-09","2024-11-15","2024-11-15","2024-11-15","2024-09-30","2024-09-30","2025-03-19","2025-03-19","2025-03-19","2024-08-02","2024-08-02","2025-08-08","2026-03-16","2025-08-08","2026-03-09","2025-10-10","2026-02-16","2025-10-13","2025-10-13","2026-03-16","2025-10-13","2024-08-01","2024-08-01","2023-12-07","2024-09-09","2024-07-01","2024-06-27","2024-07-11","2024-06-27","2024-10-30","2024-06-27","2024-06-27","2025-01-16","2024-09-12","2024-09-05","2026-01-02","2026-01-02","2026-01-02","2026-01-15","2025-06-06","2025-10-24","2026-01-15","2026-01-15","2026-03-20","2024-07-26","2024-07-26","2024-07-26","2023-11-21","2023-02-27","2023-09-28","2025-07-31","2023-01-06","2023-01-06","2025-04-09","2026-03-20","2026-02-16","2026-02-16","2026-02-16","2026-02-16","2026-02-16","2026-02-16","2025-09-12","2026-03-09","2024-08-16","2024-10-18","2023-01-10","2026-03-20","2026-03-20","2024-08-16","2024-10-30","2026-02-16","2026-02-16","2025-07-31","2025-08-14","2025-02-03","2026-03-16","2026-03-16","2025-07-09","2026-03-16","2026-03-16","2025-09-23","2026-03-16","2024-03-13","2024-03-13","2024-08-22","2024-08-22","2026-02-22","2026-02-22","2024-03-28","2026-03-16","2026-03-16","2026-03-16","2025-10-07","2025-10-03","2026-03-16","2025-10-03","2025-10-03","2024-08-11","2024-01-08","2024-01-08","2024-01-08","2025-12-11","2025-12-11","2025-12-11","2024-03-13","2024-09-30","2024-09-30","2024-09-30","2024-02-06","2023-09-11","2023-09-11","2023-09-11","2024-08-11","2025-09-08","2025-12-05","2026-03-16","2025-01-02","2024-04-01","2024-04-01","2026-03-20","2023-10-30","2025-07-17","2023-03-15","2023-03-15","2025-10-30","2023-01-25","2025-08-08","2024-09-09","2024-09-09","2026-03-12","2026-03-12","2024-08-01","2024-06-12","2024-04-04","2025-04-06","2024-05-13","2024-05-13","2024-10-30","2024-03-20","2024-03-04","2024-03-04","2024-09-06","2024-10-30","2026-01-14","2026-01-14","2026-01-14","2024-10-30","2024-03-20"],"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":[["","","Amlodipine","5 MG","","Select","Select",""],["","","Lisinopril","40 MG","","Select","Select",""],["","","Triamcinolone Acetonide","1 MG","","Select","Select",""],["","","Nitroglycerin","0.3 MG","","Select","Select",""],["","","Levothyroxine Sodium","0.025 MG","","Select","Select",""],["","","Carisoprodol","350 MG","","Select","Select",""],["","","Pregabalin","50 MG","","Select","Select",""],["","","Farxiga","10 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Levocetirizine Dihydrochloride","5 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Oxycodone-Acetaminophn 7.5-325","","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 Mg","","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Dextromethorphan Hydrobromide","3 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Dexamethasone","4 MG","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Promethazine Hydrochloride","12.5 MG","","Select","Select",""],["","","Prochlorperazine","10 MG","","Select","Select",""],["","","Famotidine","20 MG","","Select","Select",""],["","","Paxlovid 150-100 Mg Dose Pack","","","Select","Select",""],["","","Mupirocin","0.02 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","5 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Mupirocin 2% Ointment","","","Select","Select",""],["","","Hydromorphone","2 MG","","Select","Select",""],["","","Celecoxib","200 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Hydromorphone Hydrochloride","2 MG","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Lidocaine-Prilocaine Cream","","","Select","Select",""],["","","Diphenoxylate-Atrop 2.5-0.025","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Amox-Clav 875-125 Mg Tablet","","","Select","Select",""],["","","Oxycodone Hydrochloride","5 MG","","Select","Select",""],["","","Albuterol","0.83 MG","","Select","Select",""],["","","Lidocaine\/Prilocaine","","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Fluticasone Propionate","0.05 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":""}]}]}