{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Douglas Ault","gend":0,"currentgend":"","add":"1950 Meadowbrook Cir NW","city":"Dalton","state":"GA","zip":30720,"dob":"1964-03-12","age":"","mstatus":"","insh":"0000953391001","cliId":"","pno":7063138500,"cno":7063138500,"email":"dault31@yahoo.com","ename":"","eno":"","pphy":"David Denman","ppno":7068614990,"pcpadd":"4700 BATTLEFIELD PKWY STE 200","pcpcity":"RINGGOLD","pcpstate":"GA","pcpzip":30736,"pcpcounty":"","pcpid":"","pcpname":"4700 BATTLEFIELD PKWY STE 200","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"1950 Meadowbrook Cir NW","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":30720,"pcpfaxno":7068619405,"pcpnpi":1942287453,"currentgendcomment":"","pphycomment":"","uniqueid":194902,"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":["K29.50","K31.89","Z12.11","D12.3","K63.5","K64.8","Z80.0","I25.10","I10","Z95.1","J44.9","G47.33","Z87.891","J43.9","J01.90","K21.9","Z77.22","J01.80","L02.429","B37.0","L57.0","D48.5","J34.2","K76.89","K75.81","E88.810","E78.2","E66.3","Z68.28","J34.3","E78.5","K44.9","R13.13","K59.04","N40.1","R31.1","K75.9","R16.0","R05.1","J44.1","J30.9","J20.9","K74.60","Z98.890","K80.10","I25.2","K80.20","R05.9","R05.3","R06.2","R93.2","R73.9","R73.03","R94.30","G47.00","Z68.27","I49.3","R00.2","B37.81","K31.A0","R13.19","R49.0","R31.9","R07.0","I25.5","I48.92","Z12.83","L81.4","L82.1","D22.5","D23.9","B07.9","L82.0","I48.4","Z86.2","K31.A11","K29.60","M18.11","S62.524","S60.351","M79.644","S69.91X","R94.31","I23.1","I45.19","Z13.6","R04.0","D69.6","I34.0","I51.89","R05.8","I48.91","Z71.89","E11.9","L08.9","K74.69","R10.11","D18.01","J34.9","R13.10","K64.9","Z87.19","H10.13","Z01.818","D23.71","H00.014","K20.90","S05.92X","Z87.898","N41.9","R31.29","R06.02","J22","J43.2","J84.10","D71","Z16.20","Z95.5","L28.2","R91.8","Z78.9","J43.8","Z86.16","H00.021","R21","L85.3","L57.8"],"date":["2025-03-31","2025-03-31","2024-01-18","2024-01-18","2024-01-18","2024-01-18","2025-03-31","2025-10-31","2025-11-08","2025-04-21","2025-10-24","2025-03-31","2024-10-29","2025-10-31","2023-12-13","2025-12-01","2024-10-15","2025-11-08","2025-11-08","2025-11-08","2025-11-20","2025-11-20","2024-10-29","2025-06-27","2025-06-27","2025-06-27","2025-06-27","2025-06-27","2025-06-27","2024-10-29","2025-10-31","2025-03-31","2025-03-31","2025-12-01","2025-02-21","2025-02-21","2025-05-28","2025-05-28","2025-02-10","2025-02-14","2026-02-19","2025-11-25","2025-05-28","2025-04-22","2023-03-29","2023-04-12","2025-04-18","2024-01-25","2023-09-21","2023-04-18","2025-04-18","2025-10-24","2025-10-31","2024-10-28","2023-10-17","2025-06-27","2025-05-30","2025-05-30","2025-03-31","2025-12-01","2025-12-01","2025-03-24","2025-02-26","2025-02-26","2024-11-22","2025-04-21","2025-03-21","2025-03-21","2025-03-21","2025-03-21","2024-04-05","2024-04-05","2023-02-01","2024-11-22","2025-04-22","2024-01-18","2025-03-31","2025-03-18","2025-03-18","2025-03-18","2025-03-15","2025-03-15","2024-10-30","2024-10-30","2024-10-30","2024-10-30","2024-10-25","2024-10-28","2023-04-18","2023-04-07","2025-06-14","2023-10-12","2024-10-15","2025-10-24","2024-07-03","2025-10-31","2025-04-08","2023-10-31","2025-04-22","2025-03-31","2024-10-10","2025-04-10","2023-05-09","2024-10-25","2025-03-21","2024-09-04","2025-03-31","2023-07-20","2023-07-20","2025-03-03","2025-03-03","2023-04-07","2023-10-13","2024-04-15","2023-10-13","2023-10-13","2023-09-21","2023-07-17","2023-08-05","2023-10-13","2023-03-17","2024-04-15","2024-04-15","2024-06-17","2023-08-07","2023-08-07","2023-08-07"],"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":[["","","Rosuvastatin Calcium","20 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Fluorometholone","1 MG","","Select","Select",""],["","","24 Hr Diltiazem Hydrochloride","180 MG","","Select","Select",""],["","","Valsartan","160 MG","","Select","Select",""],["","","Trelegy Ellipta 100-62.5-25","","","Select","Select",""],["","","Nystatin 100000 Unt\/Ml Oral Suspension","","","Select","Select",""],["","","Fluconazole","100 MG","","Select","Select",""],["","","Lansoprazole Dr","30 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Dextromethorphan Hydrobromide","3 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Benzonatate","200 MG","","Select","Select",""],["","","Desloratadine","5 MG","","Select","Select",""],["","","Esomeprazole","40 MG","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","Promethazine Hydrochloride","1.25 MG","","Select","Select",""],["","","Paxlovid 300-100 Mg Dose Pack","","","Select","Select",""],["","","Amox-Clav 875-125 Mg Tablet","","","Select","Select",""],["","","Gentamicin 0.1% Ointment","","","Select","Select",""],["","","Sulfamethoxazole","400 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Trelegy Ellipta","","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Meloxicam","7.5 MG","","Select","Select",""],["","","Sucralfate","1000 MG","","Select","Select",""],["","","Farxiga","","","Select","Select",""],["","","Mupirocin","","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Fluorouracil","50 MG","","Select","Select",""],["","","Spiriva Handihaler","18 MCG","","Select","Select",""],["","","Levofloxacin","500 MG","","Select","Select",""],["","","Ipratropium Bromide","0.042 MG","","Select","Select",""],["","","Valacyclovir","1000 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Ofloxacin","3 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 Mg","","","Select","Select",""],["","","Mupirocin 2% Ointment","","","Select","Select",""],["","","Tamsulosin Hydrochloride","0.4 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Plecanatide","3 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":""}]}]}