{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nathan Holt","gend":0,"currentgend":"","add":"610 Chenocetah Dr","city":"Cornelia","state":"GA","zip":30531,"dob":"1982-12-07","age":"","mstatus":"","insh":"0002229520001","cliId":"","pno":7064997868,"cno":"","email":"nateholt34@yahoo.com","ename":"","eno":"","pphy":"James Murphey","ppno":7068651234,"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":"610 Chenocetah Dr","madd2":"","madd3":"","mcity":"Cornelia","mstate":"GA","mzip":30531,"pcpfaxno":"","pcpnpi":1740472208,"currentgendcomment":"","pphycomment":"","uniqueid":240988,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L57.8","L55.9","L82.0","D22.5","L82.1","Z09","Z87.2","L57.0","I10","E78.49","E29.1","R53.81","R53.83","Z79.899","Z00.00","E55.9","M51.17","E66.09","Z68.32","E66.811","R97.20","R19.7","R10.11","E78.2","Z12.5","G47.33","J45.40","E66.9","F41.9","Z68.34","M54.17","I26.99","R74.8","Z87.891","Z68.30","K21.9","I26.09","K85.30","R10.9","K76.0","K85.90","Z12.11","Z80.0","K85.80","D75.1","M54.42","Z68.33","I51.7","M54.16","F41.1","F51.01","J45.30","K58.0","K64.4","F41.8"],"date":["2025-05-22","2025-05-22","2025-05-22","2025-05-22","2025-05-22","2024-05-16","2024-05-16","2024-05-16","2026-03-05","2026-03-05","2026-03-05","2025-06-27","2026-03-05","2026-03-05","2026-03-10","2026-03-05","2025-01-21","2026-03-10","2026-03-10","2026-03-10","2025-06-27","2025-08-21","2026-01-22","2024-05-02","2024-05-02","2024-07-23","2024-05-02","2024-05-02","2024-05-02","2025-01-30","2025-02-20","2025-06-27","2025-08-21","2025-03-25","2025-08-21","2025-08-21","2025-04-07","2025-03-28","2025-03-25","2025-03-28","2026-02-25","2026-02-25","2026-02-25","2026-03-18","2025-12-26","2024-12-12","2026-02-05","2025-03-25","2024-12-23","2024-07-23","2024-07-23","2024-07-23","2024-07-23","2024-07-23","2024-12-23"],"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":[["","","Pantoprazole","40 MG","","Select","Select",""],["","","Diclofenac Sodium","75 MG","","Select","Select",""],["","","Escitalopram","10 MG","","Select","Select",""],["","","Trazodone Hydrochloride","50 MG","","Select","Select",""],["","","Testosterone Cyp","200 MG","","Select","Select",""],["","","Lisinopril","40 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Budesonide-Formoterol 160-4.5","","","Select","Select",""],["","","Diazepam","10 MG","","Select","Select",""],["","","Testosterone Cypionate","","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Budesonide\/Formoterol Fumarate Dihydrate","","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Losartan Potassium","","","Select","Select",""],["","","Symbicort","","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","Sodium Sulfate\/Potassium Sulfate\/Magnesium Sulfate","","","Select","Select",""],["","","Testosterone Cyp 2,000 Mg\/10Ml","","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Zaleplon","5 MG","","Select","Select",""],["","","Hydrocortisone Acetate","25 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Cefuroxime","250 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":""}]}]}