{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pamela Sullens","gend":1,"currentgend":"","add":"267 Arrowood Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"1970-02-03","age":"","mstatus":"","insh":"0004816734001","cliId":"","pno":7067250212,"cno":7067250212,"email":"pamsullens4@gmail.com","ename":"","eno":"","pphy":"Derek Klemm","ppno":7067544348,"pcpadd":"17 WHITE ST","pcpcity":"CLEVELAND","pcpstate":"GA","pcpzip":30528,"pcpcounty":"","pcpid":"","pcpname":"17 WHITE ST","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"267 Arrowood Rd","madd2":"","madd3":"","mcity":"Cleveland","mstate":"GA","mzip":30528,"pcpfaxno":7067540731,"pcpnpi":1225300494,"currentgendcomment":"","pphycomment":"","uniqueid":291192,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F17.210","R06.02","R79.89","R06.09","E66.9","E78.5","I25.10","M79.601","I49.8","I25.2","Z95.5","R73.03","R53.83","Z11.59","R51.9","L03.811","N39.0","F41.9","R60.0","Z13.31","J40","R07.9","R07.89","I70.8","R07.2","I21.4","Z79.02","R21","I21.9","M79.7","Z68.24","E55.9","K21.9","M19.90","J30.2","L21.0","M79.89","I47.20","I25.5","E78.2","F17.200","M05.79","F51.01","N95.2","N30.10","R30.0","R13.10","K22.70","K31.89","R11.2","R10.13","I47.29","Z79.899","J01.01","R09.81","D50.8","R10.9","Z09","I44.2","J00","R05.1","D84.821","Z68.23","Z86.79","J98.11","G89.29","R10.12","R00.1","I95.2","Z68.25","D72.829","K29.50","K21.00"],"date":["2025-09-29","2025-08-31","2025-08-31","2025-08-31","2025-08-31","2026-02-18","2025-12-10","2025-09-29","2025-08-31","2026-02-18","2026-02-18","2026-02-18","2025-02-28","2025-02-28","2025-04-08","2025-04-08","2025-09-08","2026-02-18","2026-03-19","2025-04-11","2025-02-28","2025-09-29","2025-08-30","2025-08-25","2025-08-31","2025-09-10","2025-08-30","2025-08-30","2025-08-26","2026-02-18","2025-12-10","2025-04-11","2026-02-18","2026-02-18","2025-04-11","2025-04-11","2025-09-29","2025-09-08","2025-09-08","2025-11-12","2025-12-10","2025-09-08","2026-02-18","2026-02-18","2026-02-18","2026-02-18","2025-06-30","2025-06-30","2025-06-30","2025-06-30","2025-06-30","2025-08-26","2025-08-26","2026-03-19","2026-03-19","2026-03-19","2025-06-15","2025-09-10","2025-08-30","2025-11-12","2025-11-12","2025-11-12","2025-11-12","2025-08-27","2025-08-30","2025-09-10","2025-06-19","2025-08-27","2025-08-26","2025-08-26","2025-08-26","2025-06-30","2025-06-30"],"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":[["","","Omeprazole","20 MG","","Select","Select",""],["","","Hydroxyzine Pam","25 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Citalopram","40 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Ketorolac Tromethamine","10 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Citalopram Hydrobromide","","","Select","Select",""],["","","Albuterol Sulfate Hfa","","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Dicyclomine Hydrochloride","","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Sucralfate","1000 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Ticagrelor","","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Aspirin Low Dose","","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Prasugrel","10 MG","","Select","Select",""],["","","Repatha Sureclick","","","Select","Select",""],["","","Gabapentin","100 MG","","Select","Select",""],["","","Buspirone Hydrochloride","15 MG","","Select","Select",""],["","","Hydroxyzine Pamoate","","","Select","Select",""],["","","Azelastine Hydrochloride","0.137 MG","","Select","Select",""],["","","Trazodone Hydrochloride","100 MG","","Select","Select",""],["","","Lactulose","667 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Nitroglycerin","","","Select","Select",""],["","","Estradiol","0.1 MG","","Select","Select",""],["","","Rosuvastatin Calcium","10 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Diclofenac Sodium","75 MG","","Select","Select",""],["","","Promethazine Hydrochloride","25 MG","","Select","Select",""],["","","24 Hr Nicotine","0.292 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 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":""}]}]}