{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William Todd Crumbley","gend":0,"currentgend":"","add":"2418 Hicks Gap Rd","city":"Blairsville","state":"GA","zip":30512,"dob":"1965-04-25","age":"","mstatus":"","insh":"0001177653002","cliId":"","pno":7067686593,"cno":7068657528,"email":"","ename":"","eno":"","pphy":"Joe Livingston","ppno":7067459417,"pcpadd":"346 DEEP SOUTH FARM RD STE A","pcpcity":"BLAIRSVILLE","pcpstate":"GA","pcpzip":30512,"pcpcounty":"","pcpid":"","pcpname":"346 DEEP SOUTH FARM RD STE A","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"2418 Hicks Gap Rd","madd2":"","madd3":"","mcity":"Blairsville","mstate":"GA","mzip":30512,"pcpfaxno":"","pcpnpi":1679911846,"currentgendcomment":"","pphycomment":"","uniqueid":198225,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z12.5","Z13.6","Z13.1","Z79.899","M25.512","E78.2","R73.03","E04.1","M25.529","I34.0","I47.29","I25.10","Z12.11","R19.5","D12.0","D12.3","D12.2","K64.0","D12.5","H91.92","H25.9","Z68.28","K63.5","I49.01","I25.5","Z68.26","R53.83","Z68.27","M25.521","M25.522","M25.50","Z00.01","E78.00","Z79.01","R74.8","R94.4","R21","H26.9","G43.009","L03.011","M79.644","D48.5","L30.9","L81.4","L56.8","S63.91X","R42","I77.89","H25.13","E11.9","Z12.12","I10","Z90.81"],"date":["2023-03-31","2026-02-16","2023-03-31","2023-03-31","2026-02-16","2025-09-11","2026-03-09","2026-03-09","2026-03-09","2025-06-12","2025-05-09","2025-05-09","2026-03-09","2025-10-30","2025-10-30","2025-10-30","2025-10-30","2025-10-30","2025-10-30","2025-10-30","2026-02-16","2026-02-16","2026-02-16","2025-10-30","2026-03-09","2026-03-09","2024-02-29","2026-03-09","2026-03-09","2025-06-30","2025-06-30","2025-06-30","2025-06-30","2023-07-31","2023-07-31","2023-12-04","2023-09-20","2025-06-12","2025-06-12","2025-06-12","2024-06-11","2024-06-11","2025-07-09","2025-07-09","2025-07-09","2025-07-09","2023-10-24","2026-03-09","2026-03-09","2025-08-18","2025-08-18","2025-06-17","2025-10-30","2023-12-04"],"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":[["","","Rizatriptan","10 MG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Brilinta","60 MG","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Clopidogrel","75 MG","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Permethrin","50 MG","","Select","Select",""],["","","Fluticasone Propionate","0.05 MG","","Select","Select",""],["","","Polyethylene Glycol 3350","236000 MG","","Select","Select",""],["","","Metoprolol Succinate Er","","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Naproxen","500 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Triamcinolone Acetonide","0.001 MG","","Select","Select",""],["","","Repatha Sureclick","","","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":""}]}]}