{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas Killmon","gend":0,"currentgend":"","add":"1364 Pathfinder Pl","city":"Hoschton","state":"GA","zip":30548,"dob":"1990-01-24","age":"","mstatus":"","insh":"0004741191001","cliId":"","pno":7708859934,"cno":7708859934,"email":"nathankillmon@gmail.com","ename":"","eno":"","pphy":"Kelly O'Dell","ppno":7705346053,"pcpadd":"4222 FAIRBANKS DR","pcpcity":"OAKWOOD","pcpstate":"GA","pcpzip":30566,"pcpcounty":"","pcpid":"","pcpname":"4222 FAIRBANKS DR","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"1364 Pathfinder Pl","madd2":"","madd3":"","mcity":"Hoschton","mstate":"GA","mzip":30548,"pcpfaxno":7705346050,"pcpnpi":1700226131,"currentgendcomment":"","pphycomment":"","uniqueid":294874,"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":["Z0000","J45909","Z21","Z6825","F90.0","F33.1","Z68.26","Z23","F32.A","Z00.00","F33.41","G61.9","Z68.29","Z68.24","Z68.25","B20","Z13.0","Z13.220","Z68.27","G95.9","Z68.23","Z79.899","Z13.228","Z20.1","Z72.89","Z01.84","F32.89","Z13.89","Z68.22","F33.0","F41.1","F43.0","Z13.31","F41.9","M25.511","G89.29","Z11.1","Z11.3","M79.2"],"date":["2025-10-07","2025-10-07","2025-10-07","2025-10-07","2026-01-28","2025-07-31","2025-10-29","2025-10-29","2025-10-29","2026-02-03","2026-01-28","2026-01-28","2026-03-09","2024-07-25","2025-07-31","2025-10-09","2025-10-09","2025-10-09","2025-01-31","2024-04-25","2024-01-25","2025-10-09","2025-10-09","2025-08-26","2025-08-26","2025-08-26","2024-01-25","2024-04-25","2024-04-25","2025-11-25","2025-11-25","2025-11-25","2024-10-30","2024-07-25","2024-07-25","2024-07-25","2025-08-26","2025-08-26","2026-03-09"],"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":[["","","Topiramate","50 MG","","Select","Select",""],["","","Dolutegravir","50 MG","","Select","Select",""],["","","Amphetamine Aspartate","2.5 MG","","Select","Select",""],["","","24 Hr Amphetamine Aspartate","6.25 MG","","Select","Select",""],["","","Once-Daily Gabapentin","750 MG","","Select","Select",""],["","","Emtricitabine","200 MG","","Select","Select",""],["","","24 Hr Bupropion Hydrochloride","300 MG","","Select","Select",""],["","","Celecoxib","200 MG","","Select","Select",""],["","","Buspirone Hydrochloride","10 MG","","Select","Select",""],["","","Cariprazine","3 MG","","Select","Select",""],["","","Symbicort 80-4.5 Mcg Inhaler","","","Select","Select",""],["","","Dextroamp-Amphetamin","10 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Lidocaine 5% Patch","","","Select","Select",""],["","","Ibuprofen","600 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","10 MG","","Select","Select",""],["","","Rizatriptan","10 MG","","Select","Select",""],["","","Dextroamp-Amphet Er","25 MG","","Select","Select",""],["","","Diclofenac Sodium","0.01 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Amphetamine\/Dextroamphetamine","","","Select","Select",""],["","","Pregabalin","75 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":""}]}]}