{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kimberly York","gend":1,"currentgend":"","add":"41 Sugar Leaf Ln","city":"Jefferson","state":"GA","zip":30549,"dob":"1989-10-10","age":"","mstatus":"","insh":"0004227980001","cliId":"","pno":7068707564,"cno":7068707564,"email":"burrishope13@gmail.com","ename":"","eno":"","pphy":"Joshua Garrett","ppno":7067542155,"pcpadd":"225 ADAMS DRIVE","pcpcity":"DEMOREST","pcpstate":"GA","pcpzip":30535,"pcpcounty":"","pcpid":"","pcpname":"225 ADAMS DRIVE","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"41 Sugar Leaf Ln","madd2":"","madd3":"","mcity":"Jefferson","mstate":"GA","mzip":30549,"pcpfaxno":7067542166,"pcpnpi":1437174570,"currentgendcomment":"","pphycomment":"","uniqueid":271780,"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":["J02.9","Z79.899","N64.3","R42","N64.4","R11.0","O36.831","O09.521","Z3A.10","R13.10","F41.9","Z34.01","Z11.3","Z32.00","Z3A.01","O99.281","E03.9","R53.83","R52","G89.29","O03.9","O02.1","Z3A.00","Z68.32","Z34.92","Z3A.30","Z34.91","K20.0","Z68.41","E03.8","E11.9","E55.9","Z00.00","Z36.89","O99.013","O26.43","O09.523","Z3A.38","Z68.39","M54.50","O48.0","Z3A.40","Z37.0","Z32.02","Z30.430","R30.0","O42.913","Z3A.39","R50.9","J10.1","M79.604","M79.605","R39.9","O99.284","O69.81X","O76","Z3A.37","Z88.0","Z91.040","Z88.1","O98.32","A60.09","O99.02","Z91.018","Z79.890","Z28.21","Z88.8","Z91.030","Z3A.19","J35.8","R07.0","O62.0","O36.80X","E66.9","N89.8","Z32.01","Z68.36","R39.89","Z68.31","Z34.82","R35.0","R10.9","Z34.93","O99.213","Z3A.35","Z34.83","O28.8","Z3A.36","J30.1","J45.909","F41.1","R00.2","K20.90","O26.891","F43.10","F32.89","Z3A.20","Z31.9","Z30.432","Z3A.11","Z3A.34","O20.0","R05.1","J01.90","R68.83","M94.0","B96.89","N39.0","Z3A.33","O26.852","Z3A.14","Z12.4","O99.891","N90.89","Z86.19","O23.591","R10.2","I37.1","R06.02","O26.86","F42.2","Z86.2","M79.18","O60.14X","O99.280","O47.03","R07.9","Z3A.32","K31.84","K59.00","O80","Z37.9","Z3A.23","O99.353","K21.9","O32.1XX"],"date":["2024-03-21","2026-01-06","2024-02-20","2024-02-20","2024-02-20","2025-04-17","2025-06-10","2025-06-10","2025-06-10","2024-04-17","2024-08-08","2025-05-20","2025-05-20","2024-07-05","2025-05-20","2024-04-08","2026-01-06","2026-02-25","2026-02-25","2025-05-14","2024-05-17","2024-05-06","2025-02-21","2024-05-17","2024-10-07","2025-10-27","2025-05-05","2025-11-19","2025-11-19","2025-10-14","2024-09-10","2024-09-10","2025-09-17","2025-12-22","2026-01-06","2025-12-22","2026-01-06","2025-12-22","2025-12-22","2025-05-14","2026-01-06","2026-01-06","2026-01-06","2026-03-12","2026-03-12","2024-04-25","2025-12-30","2025-12-30","2026-03-11","2026-03-11","2025-11-24","2025-11-24","2026-02-04","2025-02-20","2025-02-21","2025-02-20","2025-02-21","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2025-08-15","2024-04-12","2024-04-12","2026-01-06","2025-05-20","2024-09-19","2026-03-12","2025-05-05","2025-05-05","2024-07-05","2024-07-05","2025-10-14","2025-04-17","2025-04-17","2025-02-10","2025-12-08","2025-02-10","2025-12-08","2025-02-18","2025-12-08","2024-03-08","2024-03-08","2024-03-08","2025-11-14","2024-03-08","2024-04-08","2024-08-08","2024-08-08","2024-10-25","2024-01-05","2024-01-05","2024-08-20","2025-11-25","2024-04-30","2024-01-07","2024-01-07","2024-01-07","2024-01-07","2024-04-08","2024-01-24","2025-01-27","2024-09-16","2024-09-16","2025-04-10","2024-08-20","2025-04-10","2025-04-10","2024-04-08","2024-04-08","2025-11-24","2025-11-24","2026-01-21","2026-01-21","2026-02-04","2026-02-04","2025-02-21","2025-02-21","2025-01-27","2024-08-20","2025-11-14","2024-02-26","2024-02-26","2025-02-21","2025-02-21","2024-11-18","2025-01-02","2024-04-17","2025-10-27"],"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":[["","","Levocetirizine Dihydrochloride","5 MG","","Select","Select",""],["","","Hydroxyzine Hydrochloride","25 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Epinephrine","0.3 MG","","Select","Select",""],["","","Nystatin 100,000 Unit\/Ml Susp","","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Oxycodone Hydrochloride","5 MG","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Levothyroxine","75 MCG","","Select","Select",""],["","","Famotidine","20 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Levothyroxine Sodium","0.075 MG","","Select","Select",""],["","","Acyclovir","0.05 MG","","Select","Select",""],["","","Sulfamethoxazole","40 MG","","Select","Select",""],["","","Fluticasone Propionate","","","Select","Select",""],["","","{7 Ethinyl Estradiol","0.035 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Amoxicillin","400 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Progesterone","200 MG","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Misoprostol","0.2 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Triamcinolone Acetonide","1 MG","","Select","Select",""],["","","Paroxetine Hydrochloride","20 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":""}]}]}