{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kem Moxley","gend":1,"currentgend":"","add":"3202 Sardis Rd Apt A4","city":"Gainesville","state":"GA","zip":30506,"dob":"1966-06-14","age":"","mstatus":"","insh":"0003919111001","cliId":"","pno":7068974120,"cno":7068974120,"email":"kmoxley66@gmail.com","ename":"","eno":"","pphy":"Samuel Church","ppno":7068960505,"pcpadd":"85 SEASONS LN","pcpcity":"HIAWASSEE","pcpstate":"GA","pcpzip":30546,"pcpcounty":"","pcpid":"","pcpname":"85 SEASONS LN","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3202 Sardis Rd Apt A4","madd2":"","madd3":"","mcity":"Gainesville","mstate":"GA","mzip":30506,"pcpfaxno":8667962502,"pcpnpi":1053398149,"currentgendcomment":"","pphycomment":"","uniqueid":285542,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","E03.9","E78.2","E55.9","E11.22","I10","Z13.31","Z28.21","Z68.36","E66.01","E66.9","Z68.41","F11.20","Z79.899","Z79.1","Z79.85","T81.41X","L03.115","Z96.641","J81.0","I89.0","E11.9","N30.00","N32.81","F33.41","F41.3","F90.9","M54.10","G62.9","E03.8","F11.11","Z13.89","R29.898","M62.81","R26.81","M16.11","S52.591","M79.18","M25.531","Z47.1","I51.9","J02.9","J01.00","R09.81","Z20.822","Z68.39","H92.02","I87.2","T81.49X","D64.9","J01.90","M10.9","R11.0","R60.9","R06.02","R94.31","Z82.49","Z68.38","R05.1","Z68.37","B35.3","L97.522","L03.032","M79.672","N18.1","I12.9","R53.83","B37.31","M24.551","H61.21","H60.391","H69.91","R23.2","M25.532","R03.0","R07.9","J81.1","R06.00","R07.89","M54.6","V89.2XX","R26.89","H25.813","E53.8","M25.551","S20.211","H61.23","H90.A21","Z12.11","J01.40","J06.9","R30.0","N12","Z04.3","W19.XXX","M79.89","R39.15","M25.631","R22.31","H04.123","R51.9","I83.893"],"date":["2026-01-14","2025-09-30","2025-09-30","2025-09-30","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2024-03-19","2025-06-17","2024-04-06","2024-03-19","2024-03-19","2024-03-19","2024-04-06","2024-04-06","2024-04-18","2024-04-06","2024-04-06","2025-07-03","2023-12-11","2023-12-11","2025-06-17","2023-07-12","2025-09-30","2023-07-12","2025-09-30","2023-12-11","2025-09-30","2025-09-30","2024-04-18","2024-04-18","2024-04-18","2024-04-18","2025-06-12","2025-04-08","2025-05-01","2024-03-18","2025-09-15","2025-11-25","2025-12-27","2025-12-21","2025-02-17","2025-10-06","2025-06-17","2025-09-30","2024-04-05","2024-04-06","2025-11-25","2025-05-05","2025-12-21","2023-02-06","2024-04-05","2023-02-06","2023-02-06","2025-12-21","2025-12-27","2025-12-27","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-03-12","2025-03-12","2025-03-12","2025-03-12","2024-02-05","2024-05-06","2024-05-06","2024-11-14","2024-11-14","2025-03-22","2025-02-17","2024-04-04","2024-04-04","2024-04-04","2025-05-19","2025-05-19","2025-05-19","2024-03-07","2026-02-19","2023-07-26","2023-07-26","2025-05-19","2025-10-15","2025-10-15","2023-11-08","2025-07-28","2025-12-21","2024-11-05","2024-11-05","2025-03-22","2025-03-22","2025-03-22","2024-05-14","2025-05-01","2025-05-01","2026-02-04","2025-01-17","2025-10-28"],"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":[["","","Buprenorphine-Nalox 8-2Mg Film","","","Select","Select",""],["","","Fluoxetine","40 MG","","Select","Select",""],["","","Methylphenidate Hydrochloride","10 MG","","Select","Select",""],["","","Levothyroxine Sodium","0.025 MG","","Select","Select",""],["","","Methylphenidate","5 MG","","Select","Select",""],["","","Buprenorphine","12 MG","","Select","Select",""],["","","Vitamin B12","1 MG","","Select","Select",""],["","","Pregabalin","75 MG","","Select","Select",""],["","","Gabapentin","800 MG","","Select","Select",""],["","","Diclofenac Sodium","75 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Erythromycin 0.5% Eye Ointment","","","Select","Select",""],["","","Erythromycin","0.005 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Trulicity","0.75 MG","","Select","Select",""],["","","Nystatin 100000 Unt\/Ml Topical Cream","","","Select","Select",""],["","","Celecoxib","200 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Azelastine Hydrochloride","0.137 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Tobramycin\/Dexamethasone","","","Select","Select",""],["","","Fluoxetine Hydrochloride","","","Select","Select",""],["","","Mounjaro","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Silver Sulfadiazine","10 MG","","Select","Select",""],["","","Ketoconazole","","","Select","Select",""],["","","Cefuroxime","500 MG","","Select","Select",""],["","","Ipratropium Bromide","0.042 MG","","Select","Select",""],["","","Promethazine Hydrochloride","25 MG","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","Oxycodone\/Acetaminophen","","","Select","Select",""],["","","Fluorometholone","1 MG","","Select","Select",""],["","","Myrbetriq Er","50 MG","","Select","Select",""],["","","Mupirocin","0.02 MG","","Select","Select",""],["","","Duloxetine","20 MG","","Select","Select",""],["","","Furosemide","40 MG","","Select","Select",""],["","","Hydrocortisone","10 MG","","Select","Select",""],["","","Naproxen","500 MG","","Select","Select",""],["","","Tamsulosin Hydrochloride","0.4 MG","","Select","Select",""],["","","Dextromethorphan Hydrobromide","3 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Ketorolac Tromethamine","10 MG","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Bromphen\/Pseudoephedrine Hcl\/Dextromethorphan Hbr","","","Select","Select",""],["","","Benzonatate","100 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":""}]}]}