{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Melissa Baldwin","gend":1,"currentgend":"","add":"241 Doddville Rd","city":"Alto","state":"GA","zip":30510,"dob":"1977-06-15","age":"","mstatus":"","insh":"0003897381001","cliId":"","pno":7705304224,"cno":7705304224,"email":"mmbaldwin77@gmail.com","ename":"","eno":"","pphy":"Konstantin Zubelevitskiy","ppno":7702199000,"pcpadd":"743 SPRING ST NE","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":305013715,"pcpcounty":"","pcpid":"","pcpname":"743 SPRING ST NE","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"241 Doddville Rd","madd2":"","madd3":"","mcity":"Alto","mstate":"GA","mzip":30510,"pcpfaxno":"","pcpnpi":1881890473,"currentgendcomment":"","pphycomment":"","uniqueid":280951,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I11.9","R00.2","E78.2","F17.210","J44.1","Z99.81","E66.812","E66.2","Z68.39","E11.9","Z79.85","Z79.84","R06.00","I10","E78.5","E87.6","Z79.899","J90","J81.1","Z46.82","J98.11","R09.02","K31.89","R79.1","Z45.2","S83.241","J44.0","J18.9","J96.01","J96.02","F11.20","F13.20","G47.33","Z79.82","R07.89","E03.9","F41.8","F31.9","R47.81","R53.83","G89.29","Z90.710","Z90.49","G93.41","J96.21","J96.22","J44.89","Z68.41","N17.9","R29.810","E83.42","F43.10","Z74.01","Z79.890","M54.17","R41.82","R00.0","M46.1","M25.561","M47.26","Z79.891","R06.02","Z87.01","Z87.891","M79.659","M47.817","Z13.31","Z68.38","R07.9","F41.1","F41.9","Z13.29","F31.32","I15.8","E66.9","R73.03","Z72.0","M79.89","R10.32","R06.2","R05.1","M70.61","M25.551","M22.2X1","E55.9","F32.A","J69.0","E66.01","F31.0","R10.2","E66.1","Z68.36","F41.0","M25.552","Z01.411","N64.4","F17.200","Z11.3","Z87.42","Z86.19","M54.16","J44.9","J96.11","J96.12","M79.604","Z01.419","Z12.72","M47.816","R50.9","J40","M51.26","M62.81","E66.813","G89.4","M51.36","M17.9","R29.818","F43.9","I63.9","N28.89","R10.9","R31.9","K40.20","M47.818","E11.69","R11.0","Z68.37","M51.24","M47.814","J16.8"],"date":["2025-06-04","2025-06-04","2025-06-04","2025-06-24","2025-04-10","2025-06-04","2025-10-20","2025-06-04","2025-06-04","2025-11-21","2025-04-10","2025-05-10","2024-10-17","2025-11-21","2025-05-10","2025-05-10","2025-02-03","2025-05-08","2025-05-08","2025-05-08","2025-05-08","2025-05-08","2025-05-08","2025-08-27","2025-05-08","2026-01-23","2025-02-03","2025-05-05","2025-05-10","2025-05-10","2025-02-03","2025-02-03","2026-03-10","2025-05-10","2025-02-03","2025-05-10","2025-02-03","2025-05-10","2025-02-03","2025-02-03","2025-04-18","2025-04-28","2025-02-03","2025-05-10","2025-05-10","2025-06-03","2025-06-03","2025-06-03","2025-06-03","2025-05-10","2025-05-10","2025-06-03","2025-05-10","2025-05-10","2025-12-19","2025-05-08","2025-05-03","2026-02-19","2026-02-19","2026-01-20","2026-02-19","2026-03-03","2025-08-27","2025-09-17","2025-05-01","2025-05-21","2025-10-20","2025-10-20","2025-08-27","2024-10-17","2025-01-29","2024-10-31","2025-11-07","2024-10-31","2024-10-31","2025-02-03","2024-10-31","2024-11-05","2024-11-05","2024-11-19","2024-11-19","2024-03-06","2025-04-18","2024-03-06","2025-01-31","2025-01-29","2025-06-24","2025-06-03","2025-06-03","2025-02-20","2024-11-11","2024-11-22","2025-04-18","2025-04-18","2025-04-28","2025-04-28","2025-04-28","2025-04-28","2025-04-28","2025-04-28","2025-11-21","2025-11-07","2025-06-24","2025-06-24","2025-05-01","2025-04-28","2025-04-28","2025-03-31","2025-02-02","2025-08-27","2024-03-16","2025-05-03","2025-04-29","2026-02-19","2024-06-12","2024-06-12","2025-05-03","2025-11-21","2025-05-03","2025-02-02","2025-02-02","2024-11-05","2025-02-20","2025-01-30","2025-11-07","2025-05-21","2025-11-07","2024-03-16","2024-03-16","2024-11-26"],"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":[["","","Nicotine Transdermal System","","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Lorazepam","1 MG","","Select","Select",""],["","","Potassium Chloride","10 MEQ","","Select","Select",""],["","","Aripiprazole","5 MG","","Select","Select",""],["","","Lisinopril","40 MG","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Levothyroxine Sodium","0.075 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Atenolol","25 MG","","Select","Select",""],["","","Escitalopram","10 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Duloxetine","30 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Dextromethorphan Hydrobromide","3 MG","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","Spiriva Respimat","1.25 MCG","","Select","Select",""],["","","24 Hr Metformin Hydrochloride","500 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Stiolto Respimat","","","Select","Select",""],["","","Albuterol","0.83 MG","","Select","Select",""],["","","Albuterol Sulfate Hfa","","","Select","Select",""],["","","Aspirin Low Dose","","","Select","Select",""],["","","Clonidine Hydrochloride","0.1 MG","","Select","Select",""],["","","Rosuvastatin Calcium","20 MG","","Select","Select",""],["","","Buspirone Hydrochloride","10 MG","","Select","Select",""],["","","24 Hr Nicotine","0.875 MG","","Select","Select",""],["","","Aspirin","81 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Albuterol Sul","2.5 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Brompheniramine Maleate","0.4 MG","","Select","Select",""],["","","Levofloxacin","500 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Potassium Chloride Er","","","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":""}]}]}