{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda Gail Moon","gend":1,"currentgend":"","add":"1205 Sunset Dr SE","city":"Winder","state":"GA","zip":30680,"dob":"1970-08-13","age":"","mstatus":"","insh":"0004025776002","cliId":"","pno":7708686076,"cno":7708686076,"email":"pmoon1007@gmail.com","ename":"","eno":"","pphy":"James Splichal","ppno":7063532990,"pcpadd":"20 SATELLITE DR","pcpcity":"WINDER","pcpstate":"GA","pcpzip":30680,"pcpcounty":"","pcpid":"","pcpname":"20 SATELLITE DR","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"1205 Sunset Dr SE","madd2":"","madd3":"","mcity":"Winder","mstate":"GA","mzip":30680,"pcpfaxno":7063532992,"pcpnpi":1588619142,"currentgendcomment":"","pphycomment":"","uniqueid":314826,"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":["C50.412","Z51.11","G93.41","J18.9","J96.01","R65.21","I10","E03.9","K76.0","R13.10","E86.1","I95.89","R19.7","Z85.3","G89.29","Z92.21","Z92.3","M79.7","Z87.11","Z98.1","Z90.13","Z87.891","Z17.0","C77.3","M54.9","F41.8","N61.0","G89.4","Z79.891","R41.82","E87.6","R07.9","C50.912","G57.93","G24.9","Z79.899","Z82.49","Z82.61","Z83.3","Z83.49","F06.4","R13.12","E87.20","G93.40","R55","M47.817","T85.79X","M47.814","Z51.81","I95.9","E55.9","Z13.220","R79.89","R00.0","C50.919","M47.812","G89.18","G89.3","Z00.00","F41.9","N95.1","R97.8","K59.03","Z51.5","Z45.2","R91.8","Z46.82","J90","I50.9","R10.9","Z86.69","Z87.09","R11.0","A41.9","I34.0","M46.02","R09.02","Z68.22","R06.02","M54.16","M79.641","M25.561","Z68.20","G92.8","N60.11","R92.0","N30.01","R11.2","R07.89","R52","R39.9","F32.1","Z68.1","Z01.818","K57.30","K59.00","R10.13","K02.9"],"date":["2026-02-18","2023-08-29","2025-06-16","2025-06-23","2025-06-16","2025-06-16","2025-06-16","2026-01-12","2025-06-16","2025-06-16","2025-06-23","2025-06-16","2025-12-15","2025-12-08","2025-12-08","2025-06-16","2025-06-16","2026-01-12","2025-06-16","2025-06-16","2025-12-08","2025-12-15","2025-12-08","2024-09-20","2023-04-03","2023-03-07","2025-12-08","2026-02-18","2026-01-07","2025-06-07","2023-10-06","2023-10-06","2025-05-15","2023-10-06","2023-10-06","2026-01-12","2023-10-06","2023-10-06","2023-10-06","2023-10-06","2026-02-18","2025-06-23","2025-06-04","2025-06-04","2025-06-04","2026-01-07","2025-12-08","2025-04-10","2023-03-23","2026-01-07","2026-01-07","2026-01-07","2026-01-12","2025-06-04","2025-06-04","2026-01-07","2023-03-06","2026-01-07","2026-01-12","2026-02-18","2026-01-12","2026-02-18","2025-04-22","2024-09-18","2025-06-12","2025-06-12","2025-06-12","2025-06-12","2025-06-12","2025-04-10","2025-06-23","2025-06-23","2025-06-23","2025-06-08","2025-06-05","2024-04-11","2025-06-04","2025-09-03","2025-06-13","2026-01-07","2026-01-07","2026-01-07","2026-01-07","2023-10-06","2023-03-06","2023-03-06","2025-04-28","2023-10-04","2023-10-04","2023-10-04","2025-04-28","2025-04-22","2025-04-22","2024-11-19","2023-10-04","2024-10-25","2025-12-15","2025-04-10"],"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":[["","","Levothyroxine Sodium","0.088 MG","","Select","Select",""],["","","Duloxetine","30 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Escitalopram","20 MG","","Select","Select",""],["","","Alprazolam","0.25 MG","","Select","Select",""],["","","Baclofen","10 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 10-325 Mg","","","Select","Select",""],["","","Mupirocin","0.02 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 10-325","","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Prochlorperazine","10 MG","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Lidocaine 2% Viscous Soln","","","Select","Select",""],["","","0.6 Ml Pegfilgrastim-Bmez","10 MG","","Select","Select",""],["","","Pantoprazole Sod Dr","20 MG","","Select","Select",""],["","","Lidocaine-Prilocaine Cream","","","Select","Select",""],["","","Hydromorphone Hydrochloride","4 MG","","Select","Select",""],["","","Hydromorphone","4 MG","","Select","Select",""],["","","Oxycodone-Acetaminophn 7.5-325","","","Select","Select",""],["","","Oxycodone Hcl Ir","10 MG","","Select","Select",""],["","","Lidocaine 5% Patch","","","Select","Select",""],["","","Silver Sulfadiazine","10 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Tamoxifen","20 MG","","Select","Select",""],["","","Letrozole","2.5 MG","","Select","Select",""],["","","Naloxone Hcl","4 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Exemestane","25 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Prednisone","5 MG","","Select","Select",""],["","","Buprenorphine","0.15 MG","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","24 Hr Venlafaxine","75 MG","","Select","Select",""],["","","Journavx","","","Select","Select",""],["","","Oxycodone\/Acetaminophen","","","Select","Select",""],["","","Promethazine Hydrochloride","12.5 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","10 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Lidocaine","25 MG","","Select","Select",""],["","","Oxycodone Hydrochloride","10 MG","","Select","Select",""],["","","Hydroxyzine Hydrochloride","10 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Pantoprazole Sodium","","","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":""}]}]}