{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Samuel Ladean Burchfield","gend":0,"currentgend":"","add":"1687 Ross Ln","city":"Dalton","state":"GA","zip":30721,"dob":"1982-01-27","age":"","mstatus":"","insh":"0000998756001","cliId":"","pno":7064832420,"cno":7064832420,"email":"lucilleburchfield2@hotmail.com","ename":"","eno":"","pphy":"Timothy Snodgrass","ppno":7065293245,"pcpadd":"1107 MEMORIAL DR STE 200","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"1107 MEMORIAL DR STE 200","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"1687 Ross Ln","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":30721,"pcpfaxno":7062726077,"pcpnpi":1962484055,"currentgendcomment":"","pphycomment":"","uniqueid":194745,"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":["K52.9","R65.10","Z20.822","R05.9","K76.0","E78.5","Z79.899","K29.50","E66.9","Z68.35","B34.9","R11.2","R19.7","Z03.818","R68.89","A09","K21.00","H40.013","H04.123","H52.13","H52.223","M79.672","J01.80","E66.8","K21.9","J31.0","E78.2","Z11.59","R05.1","L98.0","I10","R74.01","K59.00","R14.0","J01.01","H40.111","Z00.00","R50.9","A04.5","R73.09","E66.812","H40.9","D48.5","L82.1","R10.9","R68.81","K29.70","K22.89","H52.02","H52.11","K29.60"],"date":["2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-11-01","2023-11-03","2023-08-30","2023-01-12","2023-11-01","2024-09-05","2023-11-20","2023-08-19","2023-08-19","2023-08-30","2023-08-30","2023-08-19","2023-01-12","2024-09-16","2026-01-27","2025-06-24","2026-01-27","2024-09-05","2024-09-05","2024-09-05","2026-03-03","2024-09-05","2026-03-03","2023-12-18","2024-05-25","2026-01-13","2026-03-03","2023-08-17","2023-08-17","2023-08-17","2024-05-25","2026-01-27","2026-03-03","2023-08-30","2023-08-30","2025-09-09","2025-09-09","2025-09-09","2026-01-13","2026-01-13","2023-02-28","2023-02-28","2023-02-28","2023-01-12","2026-01-27","2026-01-27","2023-01-12"],"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":[["","","Loteprednol Etabonate","5 MG","","Select","Select",""],["","","Fluticasone Propionate","0.05 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Losartan Potassium","50 MG","","Select","Select",""],["","","Latanoprost","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":""}]}]}