{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna Melton","gend":1,"currentgend":"","add":"709 Crane Way","city":"Tunnel Hill","state":"GA","zip":30755,"dob":"1962-05-05","age":"","mstatus":"","insh":"0004060051001","cliId":"","pno":7066732219,"cno":7066732219,"email":"shlynnk@gmail.com","ename":"","eno":"","pphy":"Walid Omer","ppno":7157354609,"pcpadd":"1200 MEMORIAL DR","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"1200 MEMORIAL DR","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"709 Crane Way","madd2":"","madd3":"","mcity":"Tunnel Hill","mstate":"GA","mzip":30755,"pcpfaxno":"","pcpnpi":1386909737,"currentgendcomment":"","pphycomment":"","uniqueid":200574,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K74.60","K76.82","K75.81","J96.01","J01.90","F33.2","F40.01","F43.12","R53.83","Z11.4","Z00.00","I10","E78.00","E11.9","E66.811","Z68.29","R53.82","Z12.31","E55.9","E78.5","E11.65","E11.42","D73.1","D69.59","E88.819","E61.2","K76.6","E66.01","Z68.38","R18.8","Z28.21","Z68.37","E88.81","D69.6","Z79.4","Z79.85","E11.29","N18.4","E78.1","F32.A","E11.22","N18.2","E16.2","Z91.89","Z79.899","I50.33","I16.0","J90","K72.90","R56.9","N17.9","B37.31","R41.82","Z13.6","R16.2","Z68.39","E88.810","G93.89","Z68.30","R30.0","M25.511","S40.011","A41.9","J96.21","J18.9","R65.20","I46.9","D61.818","D68.9","I11.0","J91.8","J94.8","M25.551","M54.16","Z79.891","G89.4","M79.10","M51.26","M51.36","M47.816","Z23","N28.89","R29.6","Z28.29","Z21","E66.9","Z91.148","Z68.41","M46.1","E66.3","I67.82","Z68.34","M54.50","G89.29","F41.9","Z68.35","Z68.36","K83.8","I51.7","I34.81","S52.532","G31.84","R06.83","G47.00","G47.10","E66.812","M70.61","S01.81X","K75.9","M54.17","K74.69","D69.9","M79.18","G93.40","G25.3","J18.1","Z12.89","K58.1","F43.9","Z68.42","M16.11","M43.16","R29.90","M47.817","Z68.33","K76.81","M75.101","M75.81","M94.8X1","M75.121","M19.011","R20.0","I73.9","G47.30","R47.01"],"date":["2026-03-12","2026-03-12","2026-03-12","2025-12-11","2024-01-04","2026-03-04","2026-03-04","2026-03-04","2023-06-23","2023-06-23","2026-03-16","2026-03-16","2026-03-16","2026-03-16","2026-03-16","2026-03-16","2026-03-16","2026-03-16","2025-06-16","2025-06-16","2026-03-12","2025-06-16","2026-03-12","2026-03-12","2026-03-12","2024-04-23","2026-03-12","2025-09-18","2025-09-18","2026-03-12","2025-09-18","2023-11-08","2023-09-27","2023-10-12","2025-09-18","2025-12-22","2024-06-06","2024-06-06","2024-06-06","2025-12-02","2025-06-16","2025-06-16","2025-06-16","2025-06-16","2025-06-16","2025-12-11","2025-12-10","2025-12-11","2026-01-02","2026-01-02","2026-01-02","2026-01-02","2025-12-06","2025-12-03","2026-03-12","2023-10-12","2026-03-12","2025-12-07","2026-01-21","2025-12-31","2026-01-29","2026-01-29","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-07","2025-12-02","2026-03-12","2024-02-06","2024-01-19","2023-12-14","2024-01-19","2024-01-19","2024-01-19","2024-01-19","2024-01-19","2025-08-13","2025-12-06","2025-12-06","2023-12-19","2023-06-29","2024-12-05","2026-03-12","2023-08-17","2024-01-19","2026-03-12","2024-08-07","2025-09-18","2024-06-28","2024-06-28","2024-06-28","2024-02-21","2024-04-23","2025-12-02","2025-12-03","2025-12-03","2024-12-19","2026-02-04","2026-02-04","2026-02-04","2026-02-04","2025-09-18","2024-02-19","2025-08-13","2023-09-27","2023-12-14","2025-12-03","2023-07-03","2023-09-21","2025-12-08","2025-12-08","2025-12-02","2023-12-19","2024-02-21","2023-11-15","2023-11-15","2024-02-06","2024-02-06","2025-12-07","2023-12-14","2025-05-05","2023-08-09","2026-02-19","2026-02-19","2026-02-19","2026-03-03","2026-03-03","2024-07-24","2024-07-24","2024-07-24","2025-12-07"],"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",""],["","","Potassium Chloride","20 MEQ","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Toujeo Solostar 300 Unit\/Ml","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Paroxetine Hydrochloride","30 MG","","Select","Select",""],["","","Alprazolam","2 MG","","Select","Select",""],["","","24 Hr Nifedipine","30 MG","","Select","Select",""],["","","Trazodone Hydrochloride","150 MG","","Select","Select",""],["","","Novolog 100 Unit\/Ml Flexpen","","","Select","Select",""],["","","Celecoxib","50 MG","","Select","Select",""],["","","Lactulose","667 MG","","Select","Select",""],["","","Mounjaro","7.5 MG","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","Torsemide","10 MG","","Select","Select",""],["","","Rifaximin","550 MG","","Select","Select",""],["","","Hyoscyamine Sulfate","0.125 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 7.5-325","","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Buspirone Hcl","15 MG","","Select","Select",""],["","","Ursodiol","500 MG","","Select","Select",""],["","","Buspirone Hydrochloride","15 MG","","Select","Select",""],["","","Freestyle Libre 3 Plus\/Sensor\/Glucose Monitoring System","","","Select","Select",""],["","","Lorazepam","","","Select","Select",""],["","","Carvedilol","25 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Lidocaine","25 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Benzonatate","100 MG","","Select","Select",""],["","","Polyethylene Glycol 3350","236000 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 Mg","","","Select","Select",""],["","","Toujeo Solostar","","","Select","Select",""],["","","Novolog Flexpen","","","Select","Select",""],["","","Nystatin","","","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":""}]}]}