{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paula Pitts","gend":1,"currentgend":"","add":"4827 Hunt Club Dr","city":"Flowery Branch","state":"GA","zip":30542,"dob":"1967-07-26","age":"","mstatus":"","insh":"0003870177001","cliId":"","pno":6786171688,"cno":6786171688,"email":"pgpdrpjrp@gmail.com","ename":"","eno":"","pphy":"Devi Sampat","ppno":7702975700,"pcpadd":"725 JESSE JEWELL PKWY SE","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":305013834,"pcpcounty":"","pcpid":"","pcpname":"725 JESSE JEWELL PKWY SE","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"4827 Hunt Club Dr","madd2":"","madd3":"","mcity":"Flowery Branch","mstate":"GA","mzip":30542,"pcpfaxno":7707181877,"pcpnpi":1104212778,"currentgendcomment":"","pphycomment":"","uniqueid":280893,"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":["C50.512","C77.3","Z17.0","Z51.11","T78.40X","R11.0","T45.1X5","T82.898","I82.890","Z13.31","Z79.811","M85.89","G62.0","L65.9","Z68.30","E66.811","R21","K59.00","Z68.28","N63.14","N63.21","C50.812","K59.03","Z68.29","N18.30","L65.8","Z90.12","M65.4","Z79.899","I10","M25.531","R92.8","N63.23","R59.0","Z80.3","J02.0","N18.31","Z80.2","Z98.51","R05.1","J01.90","Z20.822","B96.89","R92.2","Z00.00","R03.0","D70.1","M62.838","B37.2","R50.9","B00.1","D63.0","Z79.1","Z79.52","I87.2","J02.9","Z01.419","Z12.4","N95.1","R53.0","R05.9","R23.2","R39.198","D64.9","Z80.1","N64.89","Z45.2","J06.9","Z20.828"],"date":["2025-09-15","2024-04-19","2025-09-15","2023-11-17","2023-11-17","2023-11-17","2023-11-17","2023-09-08","2023-09-08","2025-01-13","2025-04-14","2025-01-13","2025-01-13","2025-01-13","2025-01-13","2025-01-13","2025-04-14","2024-07-12","2026-02-07","2023-07-26","2023-07-26","2024-10-21","2023-11-03","2025-04-14","2023-11-03","2023-11-03","2024-04-19","2025-06-09","2024-02-08","2024-10-21","2025-05-26","2023-06-23","2023-06-23","2023-06-23","2025-04-14","2024-02-02","2023-07-07","2023-07-07","2023-07-21","2023-11-09","2026-02-07","2026-02-07","2026-02-07","2025-09-15","2023-06-27","2023-06-27","2023-08-21","2025-12-15","2023-08-18","2024-02-02","2023-08-18","2023-08-18","2023-07-21","2023-07-21","2023-07-18","2024-02-02","2023-06-15","2023-06-15","2023-06-15","2024-02-08","2023-11-27","2023-11-27","2023-11-27","2024-10-21","2025-04-14","2023-06-20","2024-05-03","2023-11-09","2023-11-09"],"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":[["","","Promethazine Hydrochloride","25 MG","","Select","Select",""],["","","Dexamethasone","4 MG","","Select","Select",""],["","","Letrozole","2.5 MG","","Select","Select",""],["","","Ketoconazole","20 MG","","Select","Select",""],["","","Acyclovir","400 MG","","Select","Select",""],["","","Fluconazole","200 MG","","Select","Select",""],["","","Triamcinolone Acetonide","0.005 MG","","Select","Select",""],["","","Lidocaine-Prilocaine Cream","","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Levofloxacin","750 MG","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Anastrozole","1 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 Mg","","","Select","Select",""],["","","Baclofen","10 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":""}]}]}