{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John H Brown","gend":0,"currentgend":"","add":"14 Burnett Cir SW","city":"Rome","state":"GA","zip":30165,"dob":"1964-03-22","age":"","mstatus":"","insh":"0001077101001","cliId":"","pno":7062352032,"cno":7062352032,"email":"jhnhbrwn@gmail.com","ename":"","eno":"","pphy":"Robert Puckett","ppno":7062351156,"pcpadd":"1825 MARTHA BERRY BLVD NW","pcpcity":"ROME","pcpstate":"GA","pcpzip":30165,"pcpcounty":"","pcpid":"","pcpname":"1825 MARTHA BERRY BLVD NW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"14 Burnett Cir SW","madd2":"","madd3":"","mcity":"Rome","mstate":"GA","mzip":30165,"pcpfaxno":"","pcpnpi":1508835661,"currentgendcomment":"","pphycomment":"","uniqueid":255925,"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":["Z79.899","E78.2","L03.116","Z12.5","Z13.220","Z00.00","E03.9","K21.9","S81.802","M15.9","N52.9","Z85.46","N18.31","L88","R60.0","L90.5","L53.9","L92.9","L81.9","T14.8XX","R05.3","M25.551","M15.0","M25.562","M54.50","H02.402","H04.129","G89.29","Z79.890","R05.1","J32.9","J04.0","R50.9","S81.852","M79.605","Z13.6","I96","M06.9","M79.89","L98.7","R26.9","L30.9","C41.1","D23.72","J01.80","J20.9","J01.81","R07.0","Z20.828","J20.8","R22.0"],"date":["2025-01-31","2026-01-29","2024-06-25","2025-01-20","2026-01-27","2025-07-29","2026-01-29","2026-01-29","2024-12-23","2024-07-02","2026-01-29","2026-01-29","2026-01-29","2025-01-31","2024-12-31","2024-12-31","2024-12-31","2024-12-31","2025-05-15","2025-01-16","2024-09-28","2025-05-10","2026-01-29","2025-07-29","2026-01-29","2025-07-29","2025-07-29","2026-01-29","2023-06-27","2026-03-01","2026-03-01","2026-03-01","2025-02-20","2024-12-11","2024-12-17","2025-07-24","2024-07-30","2025-01-31","2024-07-30","2024-07-30","2024-07-30","2025-04-14","2026-01-23","2024-12-23","2025-02-20","2024-09-10","2025-11-07","2024-03-26","2024-01-11","2024-01-11","2026-01-23"],"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":[["","","Levothyroxine Sodium","0.112 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","10 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Fenofibrate","160 MG","","Select","Select",""],["","","Celecoxib","200 MG","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Dextromethorphan Hydrobromide","3 MG","","Select","Select",""],["","","Lidocaine 5% Patch","","","Select","Select",""],["","","Azelastine Hydrochloride","0.137 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Mupirocin 2% Ointment","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Clobetasol Propionate","0.0005 MG","","Select","Select",""],["","","Albuterol Sulfate Hfa","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Cyclobenzaprine","10 MG","","Select","Select",""],["","","Paxlovid 300-100 Mg Pack (Eua)","","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Lidocaine","0.05 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Azithromycin","","","Select","Select",""],["","","Promethazine Dm","","","Select","Select",""],["","","Levocetirizine Dihydrochloride","5 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":""}]}]}