{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Crystal Payne","gend":1,"currentgend":"","add":"158 Garrison Ct","city":"Temple","state":"GA","zip":30179,"dob":"1970-09-23","age":"","mstatus":"","insh":"0002000417001","cliId":"","pno":7706968934,"cno":7706968934,"email":"crystal@westgamls.com","ename":"","eno":"","pphy":"Randolph Sumner","ppno":7062909222,"pcpadd":"101 REDMOND RD NW","pcpcity":"ROME","pcpstate":"GA","pcpzip":30165,"pcpcounty":"","pcpid":"","pcpname":"101 REDMOND RD NW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"158 Garrison Ct","madd2":"","madd3":"","mcity":"Temple","mstate":"GA","mzip":30179,"pcpfaxno":7062900045,"pcpnpi":1700871555,"currentgendcomment":"","pphycomment":"","uniqueid":233112,"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":["D50.8","E78.2","R73.09","E11.9","Z13.89","I47.10","Z68.26","Z98.84","G47.00","R55","R79.89","R51.0","J34.3","J34.89","J02.8","J32.8","I10","N30.01","E66.01","E44.1","I45.6","N95.1","F51.01","M25.531","M65.841","Z13.820","Z01.810","R00.2","M54.31","Z68.27","I48.0","M17.12","I48.91","I36.1","Z00.00","M79.631","J02.9"],"date":["2026-01-07","2026-01-07","2026-01-07","2025-12-15","2025-12-15","2025-12-15","2024-07-30","2024-07-30","2025-11-20","2025-11-20","2025-11-20","2025-12-10","2025-12-10","2025-12-10","2025-12-10","2025-12-10","2026-01-07","2025-05-16","2026-01-07","2024-10-23","2026-01-07","2026-01-07","2025-10-03","2025-06-02","2025-01-29","2025-01-29","2024-01-30","2025-11-18","2024-04-17","2025-12-15","2025-12-15","2024-04-17","2025-11-20","2025-11-19","2025-01-22","2025-07-29","2025-11-29"],"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":[["","","Eszopiclone","3 MG","","Select","Select",""],["","","Onetouch Verio Test Strip","","","Select","Select",""],["","","Osmotic 24 Hr Metformin Hydrochloride","1000 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","24 Hr Venlafaxine","37.5 MG","","Select","Select",""],["","","Diclofenac Sodium","75 MG","","Select","Select",""],["","","Solifenacin Succinate","10 MG","","Select","Select",""],["","","Flulaval Trivalent 2024-25 Syr","","","Select","Select",""],["","","0.5 Ml Bordetella Pertussis Filamentous Hemagglutinin Vaccine, Inactivated","0.016 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Fluarix 2025-2026","","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Onetouch Ultrasoft2","30 G","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Metformin Hydrochloride","1000 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Bisoprolol Fumarate","5 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":""}]}]}