{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kimberly Dawn Lupfer-Evans","gend":1,"currentgend":"","add":"34 Cedar Ln NW","city":"Rome","state":"GA","zip":30165,"dob":"1965-03-09","age":"","mstatus":"","insh":"0004372563001","cliId":"","pno":7708962661,"cno":7708962661,"email":"kimberlylu070@gmail.com","ename":"","eno":"","pphy":"Darshak Pandya","ppno":7062955331,"pcpadd":"504 REDMOND RD NW","pcpcity":"ROME","pcpstate":"GA","pcpzip":30165,"pcpcounty":"","pcpid":"","pcpname":"504 REDMOND RD NW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"34 Cedar Ln NW","madd2":"","madd3":"","mcity":"Rome","mstate":"GA","mzip":30165,"pcpfaxno":7062918380,"pcpnpi":1124248802,"currentgendcomment":"","pphycomment":"","uniqueid":327347,"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":["D22.5","L81.4","L82.1","L72.8","L85.3","Z08","Z85.828","Z12.31","S30.11X","I25.10","Z21","E78.5","E66.9","I11.0","I50.32","K21.9","R94.39","F17.210","R06.02","R60.0","F31.60","R01.1","Z82.49","Z68.41","Z79.899","Z88.5","R00.1","B20","E78.2","I10","Z11.1","Z11.3","Z13.220","Z12.4","R06.00","N17.9","J44.9","I13.0","N18.31","I50.9","F32.A","E66.01","Z68.42","Z79.82","Z87.891","M79.7","R09.81","J01.40","R05.1","R11.0","B00.9","R06.09","J40","R09.02","M06.9","E55.9","B35.1","E11.40","R79.89","L97.902","G25.81","M72.2","Z86.59","R07.89","R51.9","R20.9","M25.872","J44.1","J96.01","F17.218","Z13.1","E66.813","F17.200","I25.84","M26.621","R89.4","N18.32","R94.31","R00.2","R25.2","R53.1","R07.9","J96.11","F41.9","M19.90","G62.9","Z11.52","Z79.51","Z79.85","Z82.5","Z88.2","Z90.49","Z12.11","Z20.822","R50.9","J02.9","J01.00","R20.2","G24.8","M79.602","M79.601","R91.8","Z12.2","J09.X2","R06.2","M25.871","L60.0","F31.9","K22.70","M79.676","D22.61","Z12.83","D22.62","D22.71","D22.72","L82.0","L81.9","K44.9","K63.5","K64.8","D12.3","I08.0","J10.1","M85.80","K20.80","Z23","F31.62","I12.9","N18.30","A41.9","H25.13","K21.00","K25.9","I34.0","M79.604","M79.605","I21.9","J11.1","R92.323","R12","R05.9","K64.0","S69.81X","S89.81X","V43.52X","Y92.488","Z09","R73.03","G44.85","G24.09"],"date":["2025-05-23","2025-05-23","2025-05-23","2024-01-26","2024-01-26","2025-05-23","2025-05-23","2025-09-12","2026-02-12","2026-03-16","2025-01-20","2026-01-27","2025-02-27","2025-02-27","2025-02-14","2025-04-21","2024-11-01","2026-02-13","2026-01-23","2025-06-19","2025-01-20","2024-09-13","2025-07-11","2025-04-21","2026-01-27","2025-01-20","2024-09-13","2026-02-13","2025-12-23","2025-11-07","2025-12-23","2025-12-23","2026-03-16","2024-12-03","2026-01-27","2026-01-27","2026-02-13","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-03-16","2026-01-27","2026-01-27","2023-02-01","2026-02-23","2026-02-23","2026-02-23","2026-02-23","2025-06-19","2025-06-19","2026-01-23","2026-01-23","2025-08-08","2025-08-26","2025-08-08","2025-08-08","2025-08-08","2025-08-08","2025-07-31","2025-08-21","2025-12-23","2026-01-27","2025-07-11","2025-07-11","2025-08-21","2025-02-14","2025-02-14","2025-01-24","2026-03-16","2026-03-16","2025-04-21","2025-01-20","2025-08-26","2025-08-26","2026-03-05","2026-01-26","2025-02-12","2025-02-14","2025-02-12","2026-01-26","2026-02-13","2025-01-20","2025-01-20","2025-01-20","2025-01-20","2025-01-20","2025-01-20","2025-01-20","2025-01-20","2025-01-20","2023-07-17","2023-11-17","2025-01-12","2024-12-19","2024-12-19","2025-08-14","2025-08-14","2025-08-04","2025-08-04","2023-10-16","2025-12-23","2025-01-12","2025-01-12","2025-07-16","2025-07-16","2025-01-07","2026-01-27","2025-06-19","2023-01-20","2023-01-20","2023-01-20","2023-01-20","2023-01-20","2023-01-20","2023-01-20","2025-06-02","2023-07-17","2023-07-17","2023-07-17","2026-01-27","2025-01-15","2023-06-01","2025-06-02","2023-02-01","2024-03-29","2026-01-27","2026-01-27","2025-01-20","2025-06-16","2025-06-02","2025-06-02","2024-09-12","2025-08-14","2025-08-14","2025-02-27","2025-01-15","2025-09-12","2024-11-11","2024-12-19","2023-07-17","2026-02-12","2026-02-12","2026-02-12","2026-02-12","2024-09-24","2024-09-24","2026-02-16","2026-02-16"],"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":[["","","Pravastatin Sodium","40 MG","","Select","Select",""],["","","Fluoxetine","20 MG","","Select","Select",""],["","","Diclofenac Sodium","0.01 MG","","Select","Select",""],["","","Emtricitabine","200 MG","","Select","Select",""],["","","Lurasidone Hydrochloride","80 MG","","Select","Select",""],["","","Ibuprofen","400 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Clonazepam","0.5 MG","","Select","Select",""],["","","Gabapentin","800 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 Mg","","","Select","Select",""],["","","Valacyclovir","500 MG","","Select","Select",""],["","","Lumateperone","10.5 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","Serevent Diskus","","","Select","Select",""],["","","Fluticasone Propionate\/Salmeterol","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Sucralfate","1000 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","5 MG","","Select","Select",""],["","","Fluticasone Propionate","0.05 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Ipratropium Bromide\/Albuterol Sulfate","","","Select","Select",""],["","","Nystatin 100000 Unt\/Ml Oral Suspension","","","Select","Select",""],["","","Budesonide","","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Mupirocin","","","Select","Select",""],["","","Pramipexole Dihydrochloride","0.125 MG","","Select","Select",""],["","","Albuterol Sulfate Hfa","","","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":""}]}]}