{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cheyenne Buckland","gend":0,"currentgend":"","add":"146 Twin Oaks Rd","city":"Union Point","state":"GA","zip":"30669","dob":"1998-09-30","age":"","mstatus":"","insh":"0004129451001","cliId":"","pno":"7065104100","cno":"","email":"shy.buck2022@outlook.com","ename":"","eno":"","pphy":"Courtney Anderson","ppno":"7064757055","pcpadd":"1199 PRINCE AVE","pcpcity":"ATHENS","pcpstate":"GA","pcpzip":"30606","pcpcounty":"","pcpid":"","pcpname":"1199 PRINCE AVE","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"146 Twin Oaks Rd","madd2":"","madd3":"","mcity":"Union Point","mstate":"GA","mzip":"30669","pcpfaxno":"","pcpnpi":"1972965887","currentgendcomment":"","pphycomment":"","uniqueid":"325360","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":["L85.8","B35.1","Z68.25","J94.2","H04.123","S09.8XX","L85.3","S91.302","Z03.89","S25.00X","I80.02","F90.8","F31.89","I10","L60.0","R56.9","J98.4","R06.02","D75.839","R79.9","D72.829","R90.89","J32.3","M79.675","B35.3","Z13.6"],"date":["2026-07-27","2026-07-27","2026-07-27","2026-01-19","2026-02-04","2026-02-04","2026-07-10","2026-07-10","2026-06-08","2026-02-19","2026-02-19","2026-06-12","2026-06-12","2026-06-12","2026-06-12","2026-06-12","2026-06-08","2026-06-08","2026-01-22","2026-01-22","2026-01-22","2026-05-20","2026-05-20","2026-06-15","2026-06-15","2026-03-18"],"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":[["","","AMLODIPINE BESYLATE","5000 MG","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5000 MG","","Select","Select",""],["","","HYDROXYZINE HYDROCHLORIDE","25000 MG","","Select","Select",""],["","","LEVETIRACETAM","500000 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE DR","30000 MG","","Select","Select",""],["","","CITALOPRAM HYDROBROMIDE","20000 MG","","Select","Select",""],["","","CLONIDINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","BUPROPION HYDROCHLORIDE ER (XL)","300000 MG","","Select","Select",""],["","","MELOXICAM","15000 MG","","Select","Select",""],["","","AMPHETAMINE\/DEXTROAMPHETAMINE","0","","Select","Select",""],["","","CICLOPIROX NAIL LACQUER","8000 %","","Select","Select",""],["","","CICLOPIROX","770 %","","Select","Select",""],["","","ATOMOXETINE HYDROCHLORIDE","40000 MG","","Select","Select",""],["","","CICLOPIROX OLAMINE","770 %","","Select","Select",""],["","","ATOMOXETINE","60000 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":""}]}]}