{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan Vendettuoli","gend":1,"currentgend":"","add":"2650 Chimney Mountain Rd","city":"Sautee","state":"GA","zip":30571,"dob":"1970-04-25","age":"","mstatus":"","insh":"0000253102001","cliId":"","pno":7068782860,"cno":7068782860,"email":"frogpond@windstream.net","ename":"","eno":"","pphy":"Denise Workman","ppno":7063488763,"pcpadd":"55 CANTRELL RD STE 100","pcpcity":"CLEVELAND","pcpstate":"GA","pcpzip":30528,"pcpcounty":"","pcpid":"","pcpname":"55 CANTRELL RD STE 100","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"2650 Chimney Mountain Rd","madd2":"","madd3":"","mcity":"Sautee","mstate":"GA","mzip":30571,"pcpfaxno":7063481931,"pcpnpi":1780625293,"currentgendcomment":"","pphycomment":"","uniqueid":221507,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.8","R79.89","Z68.24","R20.2","F17.210","E11.65","E78.2","E11.69","F90.9","F41.1","D72.9","M48.061","J44.9","Z79.4","F31.89","E11.40","D72.829","I48.91","J02.9","Z20.822","U07.1","R52","R03.0","Z68.25","Z00.00","Z68.29","Z12.31","Z12.11","Z13.31","E11.351","R05.1","J45.901","J30.2","I10","F17.200","I95.9","E86.0","B37.0","R11.0","N30.00","Z79.891","N39.0","Z91.89","E11.352","E11.8","E06.9","M54.42","I63.9","D84.81","E10.359","R35.0","Z11.59","R10.2","Z12.4","M79.18","M47.894","M54.14","M54.16","M51.360","R26.81","M51.17","M99.63","M47.896","M54.51","M79.606","M79.605","M79.604","M51.16","M47.27","Z72.0","Z68.26","R05.3","K21.9","J06.9","M54.6","B35.1","Z12.2","J01.00","R10.30","R39.9","M16.0","M25.552","M25.551","N30.01","M51.14","M25.652","R07.9","R94.31"],"date":["2025-04-03","2025-04-03","2025-04-03","2025-04-03","2025-06-29","2026-03-05","2026-03-05","2026-03-05","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-06-27","2025-06-27","2024-07-09","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2025-06-27","2025-09-18","2025-09-18","2025-09-18","2025-09-18","2025-09-18","2025-09-18","2023-05-30","2023-05-22","2023-05-22","2023-05-22","2023-09-18","2025-07-03","2025-06-29","2025-06-26","2025-06-26","2025-06-27","2026-03-05","2026-03-05","2025-06-18","2025-07-11","2023-03-01","2023-03-01","2024-09-18","2024-06-19","2024-06-19","2026-02-18","2023-06-28","2025-06-11","2025-02-10","2025-02-10","2025-10-28","2024-12-05","2024-12-05","2025-10-28","2024-12-10","2024-12-10","2024-12-10","2024-12-10","2024-12-10","2025-10-28","2024-12-10","2024-12-05","2024-12-05","2024-12-05","2024-12-05","2025-07-23","2023-12-19","2023-12-13","2023-12-13","2023-12-13","2025-10-28","2023-06-15","2023-06-15","2023-05-30","2024-12-23","2024-12-23","2024-12-10","2024-12-10","2024-12-10","2024-11-02","2024-12-05","2024-12-10","2025-06-27","2025-06-27"],"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","80 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Lisinopril","5 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Escitalopram","20 MG","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Risperidone","2 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Trazodone Hydrochloride","100 MG","","Select","Select",""],["","","Amphetamine Aspartate","7.5 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Clonazepam","1 MG","","Select","Select",""],["","","Dextroamp-Amphetamin","30 MG","","Select","Select",""],["","","Clopidogrel","75 MG","","Select","Select",""],["","","Iprat-Albut 0.5-3","2.5 MG","","Select","Select",""],["","","Benzonatate","200 MG","","Select","Select",""],["","","Terbinafine","250 MG","","Select","Select",""],["","","Celecoxib","200 MG","","Select","Select",""],["","","Oxycodone Hydrochloride","10 MG","","Select","Select",""],["","","Oxycodone Hcl Ir","10 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Lantus Solostar 100 Unit\/Ml","","","Select","Select",""],["","","Nystatin 100,000 Unit\/Ml Susp","","","Select","Select",""],["","","Levemir Flexpen 100 Unit\/Ml","","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Ketorolac Tromethamine","10 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Nystatin 100000 Unt\/Ml Oral Suspension","","","Select","Select",""],["","","Linezolid","600 MG","","Select","Select",""],["","","Amphetamine\/Dextroamphetamine","","","Select","Select",""],["","","Toujeo Solostar","","","Select","Select",""],["","","Mounjaro","","","Select","Select",""],["","","Nda019430","0.3 ML","","Select","Select",""],["","","Dexamethasone","6 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Lidocaine Hydrochloride","20 MG","","Select","Select",""],["","","Epinephrine","0.3 MG","","Select","Select",""],["","","Gentamicin","3 MG","","Select","Select",""],["","","Toujeo Max Solostar","","","Select","Select",""],["","","Oxycodone-Acetaminophen 10-325","","","Select","Select",""],["","","Dextromethorphan Hydrobromide","3 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 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":""}]}]}