{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Timothy Fortenberry","gend":0,"currentgend":"","add":"469 Silver Falls Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"1966-12-12","age":"","mstatus":"","insh":"0001693110001","cliId":"","pno":7068092880,"cno":7068092880,"email":"jojomachado06@hotmail.com","ename":"","eno":"","pphy":"Todd Bethea","ppno":7702199260,"pcpadd":"2578 HELEN HWY","pcpcity":"CLEVELAND","pcpstate":"GA","pcpzip":30528,"pcpcounty":"","pcpid":"","pcpname":"2578 HELEN HWY","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"469 Silver Falls Rd","madd2":"","madd3":"","mcity":"Cleveland","mstate":"GA","mzip":30528,"pcpfaxno":"","pcpnpi":1710979331,"currentgendcomment":"","pphycomment":"","uniqueid":238309,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z98.1","Z79.01","R31.29","I48.0","I11.0","I50.32","M54.41","G89.29","E53.8","C44.112","E11.40","E78.00","F17.210","F41.9","I25.10","I35.0","I95.81","J44.9","R13.19","Z79.82","Z79.51","Z79.899","I65.23","I65.21","J41.0","I10","I38","M25.552","M47.816","Z68.41","R73.9","E66.01","Q23.81","E11.65","J10.1","E78.5","T38.0X5","R10.13","M46.1","E13.638","M96.1","I65.29","M17.12","M16.12","Z68.38","M48.061","M54.16","M51.369","L30.9","L82.1","Z71.89","D48.5","G89.4","J96.01","J44.1","M53.3","R73.03","R07.9","I50.30","J45.909","E66.9","G47.33","K42.9","N32.89","M51.26","M51.36","M43.17","Z79.2","H04.123","I65.22","Q23.1","M25.562","M25.652","R26.89","M79.18","R29.898","Z12.5","Z00.00","Z13.29","M70.62","R11.0","Z68.42","F17.200","M16.0","F41.1","M54.50","M51.9","N28.1","G47.00","L57.8","M54.59","Z12.11","F32.1","Z72.0","Z09","M54.2","R60.0","I27.20","M54.42","H60.91","R09.81","R39.9","R31.9","I35.1","E66.813","M47.819","Z96.82","N52.8","R42","M51.16","M47.26","J09.X2","R07.89","I16.0","Z98.890","M62.838","R06.83","H92.01","I77.810","N40.1","R39.12","K57.30","K76.89","K21.9","M15.0","Z71.6","R26.2","Z78.9","H69.81","H81.11","E66.3","H61.21","Z01.818","J42","R51.9","Z13.6","J01.91","H53.9"],"date":["2025-04-22","2025-01-29","2024-05-23","2026-01-19","2026-01-19","2026-01-19","2025-08-05","2025-08-05","2025-12-16","2024-09-19","2025-01-29","2026-01-19","2025-01-29","2024-01-17","2026-01-19","2023-02-17","2023-02-17","2025-01-30","2023-02-18","2023-02-17","2023-02-17","2024-10-29","2025-06-09","2024-05-28","2025-05-20","2025-06-09","2025-07-03","2025-09-11","2024-10-29","2026-01-19","2023-01-06","2025-01-29","2026-01-19","2025-01-29","2025-01-29","2025-01-29","2025-01-29","2024-12-27","2024-12-05","2024-11-21","2025-04-17","2025-01-02","2025-07-24","2026-03-03","2026-03-03","2025-04-17","2025-04-22","2025-04-17","2024-08-19","2024-08-19","2024-12-05","2024-08-19","2025-05-01","2025-01-26","2025-01-29","2024-10-07","2025-12-16","2025-02-11","2024-01-29","2024-01-29","2024-01-29","2026-01-12","2024-05-14","2024-04-23","2024-04-23","2024-04-23","2024-04-23","2025-04-17","2026-01-06","2025-06-04","2025-01-02","2025-09-11","2025-06-10","2025-07-03","2025-07-03","2025-07-03","2025-05-20","2025-05-20","2023-04-07","2025-07-03","2024-10-07","2025-09-03","2025-06-09","2024-12-05","2024-11-06","2024-12-05","2024-04-23","2024-05-14","2023-10-13","2024-09-19","2023-04-07","2023-04-07","2024-04-11","2024-06-20","2025-02-05","2025-02-05","2023-02-25","2024-04-11","2025-08-05","2023-07-12","2023-07-12","2024-04-23","2024-04-23","2026-02-09","2025-12-16","2024-10-03","2025-05-01","2024-11-04","2025-05-20","2024-05-10","2024-05-10","2025-01-29","2024-12-27","2024-01-29","2023-02-25","2023-01-06","2025-12-16","2024-02-01","2024-01-17","2024-04-25","2024-04-25","2024-05-14","2024-05-14","2025-09-03","2025-09-03","2024-09-12","2024-09-12","2026-01-19","2023-03-09","2023-03-09","2023-03-09","2023-03-09","2023-02-10","2023-02-10","2023-02-25","2025-06-09","2024-01-17","2025-12-16"],"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":[["","","Cephalexin","500 MG","","Select","Select",""],["","","Meclizine Hydrochloride","25 MG","","Select","Select",""],["","","Anoro Ellipta 62.5-25 Mcg Inh","","","Select","Select",""],["","","Trelegy Ellipta 100-62.5-25","","","Select","Select",""],["","","Losartan Potassium","50 MG","","Select","Select",""],["","","Baclofen","10 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Lorazepam","0.5 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","24 Hr Nifedipine","30 MG","","Select","Select",""],["","","1 Ml Evolocumab","140 MG","","Select","Select",""],["","","Alprazolam","0.5 MG","","Select","Select",""],["","","Eliquis","5 MG","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Potassium Chloride Er","","","Select","Select",""],["","","Anoro Ellipta","","","Select","Select",""],["","","Azithromycin","500 MG","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","24 Hr Nicotine","0.875 MG","","Select","Select",""],["","","Furosemide","40 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","5 MG","","Select","Select",""],["","","Oxycodone Hydrochloride","10 MG","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","Carvedilol","6.25 MG","","Select","Select",""],["","","Eq Aspirin Low Dose","","","Select","Select",""],["","","Hydrochlorothiazide","25 MG","","Select","Select",""],["","","Repatha Sureclick","","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Tobramycin\/Dexamethasone","","","Select","Select",""],["","","Potassium Cl Er","20 MEQ","","Select","Select",""],["","","Olmesartan Medoxomil","40 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","1 Ml Naloxone Hydrochloride","0.4 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Lidocaine-Prilocaine Cream","","","Select","Select",""],["","","Triamcinolone Acetonide","0.001 MG","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 5-325","","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Tramadol Hcl","50 MG","","Select","Select",""],["","","Ofloxacin","3 MG","","Select","Select",""],["","","Tamsulosin Hydrochloride","0.4 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Erythromycin","0.005 MG","","Select","Select",""],["","","Trelegy Ellipta","","","Select","Select",""],["","","Mupirocin","","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Microencapsulated Potassium Chloride","20 MEQ","","Select","Select",""],["","","Albuterol Sulfate Hfa","","","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":""}]}]}