{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maria O Salazar","gend":1,"currentgend":"","add":"468 Robinwood Cir","city":"Dalton","state":"GA","zip":30721,"dob":"1962-10-07","age":"","mstatus":"","insh":"0004365988001","cliId":"","pno":7065812218,"cno":"","email":"salazarvm@yahoo.com","ename":"","eno":"","pphy":"Seth Wagner","ppno":7062780138,"pcpadd":"1114 PROFESSIONAL BLVD","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"1114 PROFESSIONAL BLVD","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"468 Robinwood Cir","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":30721,"pcpfaxno":7062723780,"pcpnpi":1659506277,"currentgendcomment":"","pphycomment":"","uniqueid":304779,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J01.90","B96.89","I10","E11.9","E53.8","E78.1","D72.829","K59.00","Z79.4","Z79.82","Z79.899","Z85.3","Z90.710","Z88.8","Z79.85","Z79.84","R00.0","S72.002","Z00.00","R09.82","M81.0","Z13.820","E66.3","J30.1","K64.9","E11.329","H25.13","H35.413","H16.223","E55.9","R09.81","J00","Z11.59","F51.02","E46","S80.02X","S72.012","W19.XXX","M81.8","Z96.641","Z96.649","Z98.890","M17.12","Z12.31","C50.411","Z47.1","Z96.642","M25.552","R06.02","M25.462","Z91.81","R26.89","M62.81","S72.042","W01.10X","Z74.3","G89.18","Z12.11","Z12.12","J30.2"],"date":["2025-09-13","2025-09-13","2026-01-30","2026-01-30","2026-01-30","2023-10-20","2024-06-03","2024-06-04","2024-05-26","2024-05-26","2024-05-26","2024-06-03","2024-05-26","2024-05-26","2024-05-26","2024-05-26","2024-06-03","2024-09-04","2025-09-26","2024-01-19","2025-09-12","2024-10-25","2024-11-22","2025-02-14","2025-02-14","2025-02-28","2025-02-28","2025-02-28","2025-02-28","2026-01-30","2026-01-30","2025-12-04","2025-12-04","2024-06-07","2024-06-07","2024-04-05","2024-06-05","2024-05-27","2024-10-30","2024-06-26","2024-08-14","2024-06-24","2024-10-16","2025-07-11","2024-07-26","2024-05-27","2024-06-03","2024-05-26","2024-05-26","2023-11-30","2024-06-03","2024-06-03","2024-06-03","2024-06-19","2024-05-26","2024-06-03","2024-05-27","2025-08-22","2025-08-22","2024-06-05"],"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":[["","","Metformin Hydrochloride","1000 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 5-325","","","Select","Select",""],["","","Mounjaro","7.5 MG","","Select","Select",""],["","","Januvia","100 MG","","Select","Select",""],["","","Levocetirizine Dihydrochloride","5 MG","","Select","Select",""],["","","Diclofenac Sodium","75 MG","","Select","Select",""],["","","1.56 Ml Abaloparatide","2 MG","","Select","Select",""],["","","Vitamin B12","1 MG","","Select","Select",""],["","","Cyanocobalamin","","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Dexcom G7 Sensor","","","Select","Select",""],["","","Farxiga","","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Alendronic Acid","70 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Hydrocortisone","25 MG","","Select","Select",""],["","","Dextromethorphan Hydrobromide","3 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":""}]}]}