{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kelley Maravilla","gend":1,"currentgend":"","add":"37 Zona Kay Cir SE","city":"Silver Creek","state":"GA","zip":30173,"dob":"1974-06-05","age":"","mstatus":"","insh":"0003828947001","cliId":"","pno":7067670809,"cno":7067670809,"email":"kellmaravilla@yahoo.com","ename":"","eno":"","pphy":"Charles Matheny","ppno":7062955331,"pcpadd":"1825 MARTHA BERRY BLVD NW","pcpcity":"ROME","pcpstate":"GA","pcpzip":30165,"pcpcounty":"","pcpid":"","pcpname":"1825 MARTHA BERRY BLVD NW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"37 Zona Kay Cir SE","madd2":"","madd3":"","mcity":"Silver Creek","mstate":"GA","mzip":30173,"pcpfaxno":7062388011,"pcpnpi":1669569307,"currentgendcomment":"","pphycomment":"","uniqueid":278548,"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":["M18.11","M25.531","I10","E78.5","Z82.49","E11.9","E66.9","Z79.82","Z79.899","Z79.4","Z79.84","F17.200","Z68.43","K74.69","Z79.891","M51.26","M51.362","M50.321","G89.4","M25.551","M25.50","M79.641","M25.552","K74.60","L98.9","N61.0","N60.81","G47.33","Z23","E11.65","R30.0","Z86.010","E11.43","K31.84","K22.70","K76.6","K31.89","I25.10","J44.9","Z99.81","D64.9","K21.9","E66.01","R06.09","Z72.0","R60.0","I25.118","Z68.30","K75.81","R00.1","E78.2","F41.9","R00.2","G25.81","M54.17","M51.37","M25.562","M46.86","G83.21","J01.90","M79.652","R16.1","F33.1","F17.210","R05.1","N63.13","Z80.3","G47.00","K76.9","M79.631","I35.1","M48.07","M16.0","N64.4","N63.10","M51.372","D12.3","Q43.8","K62.1","Z12.31","U07.1","R06.02","R05.9","R07.89","I21.9","Z79.1","Z79.52","M62.838","M19.041","I20.9","N60.02","N95.1","Z01.812","N61.1","D23.72","L72.0","R00.0","R94.31","K63.5","N63.0","L91.8","M79.605","Z12.11","D12.8","N60.01","F41.1","J41.1","E66.813","B35.9","J44.1","J20.8","K57.30","R10.11","N39.0","M25.59","J10.1","I47.10","Z01.818","Z20.828","B34.9","M48.061","M47.816","M16.11","M16.12","N30.00","Z12.4"],"date":["2025-11-20","2026-03-11","2026-01-06","2024-01-25","2024-03-12","2024-10-24","2024-01-25","2024-01-31","2025-10-21","2026-01-06","2025-07-02","2024-10-24","2024-01-25","2026-01-06","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2025-11-20","2026-03-11","2025-12-23","2024-09-04","2024-01-31","2024-01-31","2024-01-31","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2024-10-24","2025-07-02","2023-09-28","2025-10-01","2023-09-28","2023-09-28","2024-03-12","2026-02-10","2023-09-28","2023-09-28","2024-10-24","2025-10-01","2024-03-12","2024-03-12","2024-03-12","2024-01-22","2024-03-12","2024-03-12","2024-01-22","2026-01-06","2025-07-02","2025-07-02","2025-03-26","2024-08-07","2024-08-07","2025-08-26","2025-08-26","2026-03-11","2023-09-13","2023-04-07","2025-05-06","2026-01-06","2023-03-13","2024-12-29","2024-01-02","2024-01-02","2024-06-19","2024-09-04","2024-05-14","2023-04-17","2025-10-27","2025-10-27","2023-06-20","2024-01-31","2025-07-14","2024-10-24","2023-09-28","2024-10-24","2023-06-12","2023-01-05","2023-01-05","2023-11-27","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2026-03-11","2025-11-20","2024-01-25","2024-06-27","2024-06-19","2025-05-02","2023-06-20","2024-10-24","2024-10-24","2023-01-05","2023-01-05","2024-10-24","2024-01-31","2024-01-31","2026-03-11","2024-10-24","2024-10-24","2023-06-20","2025-10-01","2026-01-06","2026-01-06","2025-10-01","2023-11-27","2023-11-27","2024-10-24","2024-01-22","2024-11-19","2026-03-11","2023-01-04","2024-03-12","2024-01-22","2024-12-29","2024-12-29","2025-10-27","2025-10-27","2023-04-07","2023-04-07","2026-01-06","2026-01-06"],"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":[["","","Humulin 70\/30 Kwikpen","","","Select","Select",""],["","","Morphine Sulf Er","15 MG","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Morphine Sulfate Ir","15 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Ozempic","2 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Glimepiride","4 MG","","Select","Select",""],["","","Olmesartan Medoxomil","5 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","50 MG","","Select","Select",""],["","","Bd Uf Nano Pen Needle 4Mmx32G","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Dicyclomine","20 MG","","Select","Select",""],["","","Hyoscyamine Sulfate","0.125 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Anoro Ellipta 62.5-25 Mcg Inh","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Ropinirole","1 MG","","Select","Select",""],["","","Clonazepam","2 MG","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","Lactulose","10 GM","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Novolin 70-30 Flexpen","","","Select","Select",""],["","","Comfort Ez Pen Needles 4Mm","32 G","","Select","Select",""],["","","Metoprolol Succ Er","25 MG","","Select","Select",""],["","","Mupirocin","0.02 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Quetiapine","50 MG","","Select","Select",""],["","","Toujeo Max Solostr 300 Unit\/Ml","","","Select","Select",""],["","","Comfort Ez Pen Needles 5Mm","31 G","","Select","Select",""],["","","Amitriptyline Hydrochloride","25 MG","","Select","Select",""],["","","Promethazine Hydrochloride","25 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Morphine Sulfate","15 MG","","Select","Select",""],["","","Toujeo Max Solostar","","","Select","Select",""],["","","Clever Choice Comfort Ez Pen Needles 31Gx5Mm","","","Select","Select",""],["","","Humalog Kwikpen","","","Select","Select",""],["","","Paxlovid 300-100 Mg Pack (Eua)","","","Select","Select",""],["","","Bd Nano 2 Gen Pen Ndl","32 G","","Select","Select",""],["","","Victoza 3-Pak","18 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Polyethylene Glycol 3350","236000 MG","","Select","Select",""],["","","Omeprazole Dr","40 MG","","Select","Select",""],["","","Benzonatate","200 MG","","Select","Select",""],["","","Trazodone Hydrochloride","50 MG","","Select","Select",""],["","","Ciprofloxacin","250 MG","","Select","Select",""],["","","Anoro Ellipta","","","Select","Select",""],["","","Sure Comfort Pen Needles 32Gx5\/32\"","","","Select","Select",""],["","","Morphine Sulfate Er","","","Select","Select",""],["","","Dicyclomine Hydrochloride","20 MG","","Select","Select",""],["","","Nystatin","","","Select","Select",""],["","","Escitalopram","10 MG","","Select","Select",""],["","","Ketoconazole","20 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Losartan Potassium","50 MG","","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":""}]}]}