{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sabrena Ann Stanfield","gend":1,"currentgend":"","add":"198 Anthony Dr NE","city":"Calhoun","state":"GA","zip":30701,"dob":"1965-01-27","age":"","mstatus":"","insh":"0001472176001","cliId":"","pno":7066293272,"cno":7062177655,"email":"sastanfield@yahoo.com","ename":"","eno":"","pphy":"Pamela Hensley","ppno":7066241001,"pcpadd":"111 LAUREL CREEK RD SE SUITE A","pcpcity":"CALHOUN","pcpstate":"GA","pcpzip":30701,"pcpcounty":"","pcpid":"","pcpname":"111 LAUREL CREEK RD SE SUITE A","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"198 Anthony Dr NE","madd2":"","madd3":"","mcity":"Calhoun","mstate":"GA","mzip":30701,"pcpfaxno":8666486516,"pcpnpi":1851834998,"currentgendcomment":"","pphycomment":"","uniqueid":237523,"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":["E83.110","E80.1","F17.210","B35.1","F17.200","E66.09","I10","Z23","L89.91","K59.00","N39.0","E66.01","G35","R30.9","R25.2","G89.29","E55.9","E53.8","L89.329","L89.319","Z87.440","G35.A","G35.D","R30.0","R35.0","R39.15","D45","B37.9","E11.65","G04.89","Z79.899","E78.5","R31.9","Z79.61","F32.A","F41.9","F34.1","J44.9","I73.9","Z00.00","M79.662","Z09","R53.83","Z00.01","Z12.39","Z12.11","E11.40","E83.42","I87.2","J10.89","J02.9","Z03.818","U07.1","N30.01","D89.2","R60.0"],"date":["2026-03-17","2026-03-17","2026-03-17","2026-02-24","2025-09-25","2025-09-25","2026-01-20","2025-09-25","2026-02-24","2026-02-24","2026-02-24","2026-02-24","2025-09-03","2025-02-04","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-11-13","2025-10-28","2025-10-28","2025-10-28","2025-09-03","2026-01-20","2026-01-20","2025-10-23","2025-10-23","2023-04-04","2024-06-24","2024-06-24","2024-06-24","2025-10-23","2025-10-23","2024-10-22","2025-04-22","2024-10-22","2025-12-17","2026-03-17","2024-10-16","2024-10-16","2024-10-30","2024-10-16","2024-10-16","2025-01-17","2024-12-31","2024-12-31","2024-12-31","2024-12-31","2024-12-31","2023-07-06","2024-10-22"],"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":[["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Citalopram","20 MG","","Select","Select",""],["","","Valsartan-Hctz 160-12.5 Mg Tab","","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Vitamin B12","1 MG","","Select","Select",""],["","","Vibegron","75 MG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Baclofen","10 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Ozempic 0.25-0.5 Mg\/Dose Pen","","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 Mg","","","Select","Select",""],["","","Hydrocodone-Acetamin 7.5-325","","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Benzonatate","200 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Valsartan","40 MG","","Select","Select",""],["","","Methenamine Hippurate","1000 MG","","Select","Select",""],["","","Fluconazole","200 MG","","Select","Select",""],["","","Chlorhexidine Gluconate","1.2 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Levofloxacin","500 MG","","Select","Select",""],["","","Dronabinol","5 MG","","Select","Select",""],["","","Terbinafine","250 MG","","Select","Select",""],["","","Chlorhexidine 0.12% Rinse","","","Select","Select",""],["","","Paxlovid 300-100 Mg Dose Pack","","","Select","Select",""],["","","Prednisone","50 MG","","Select","Select",""],["","","Valsartan\/Hydrochlorothiazide","","","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":""}]}]}