{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra L Thomas","gend":1,"currentgend":"","add":"922 Raygan Dr","city":"Tunnel Hill","state":"GA","zip":30755,"dob":"1973-06-26","age":"","mstatus":"","insh":"0004851592002","cliId":"","pno":7062606917,"cno":"","email":"","ename":"","eno":"","pphy":"Mohammad Al Azem","ppno":7704221372,"pcpadd":"1107 MEMORIAL DR STE 100","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"1107 MEMORIAL DR STE 100","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"922 Raygan Dr","madd2":"","madd3":"","mcity":"Tunnel Hill","mstate":"GA","mzip":30755,"pcpfaxno":"","pcpnpi":1174612477,"currentgendcomment":"","pphycomment":"","uniqueid":315679,"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":["E03.8","R53.83","L91.8","G43.019","M79.7","G62.9","R06.02","R07.9","Z13.6","G47.33","S52.551","M25.572","E03.9","K21.9","E66.9","Z68.38","Z87.898","Z79.890","Z79.899","Z88.5","I20.89","E66.812","Z82.49","E66.01","Z68.37","F41.1","G43.719","R07.89","R06.09","D51.0","E55.9","E53.8","T84.84X","M47.816","M79.18","R06.01","G43.701","R29.818","Z01.419","Z13.31","N95.1","M47.896","M47.812","M54.16","G93.2","R41.3","R53.81","G25.81","E87.20","R79.89","F41.9","Z98.890","Z90.710","Z90.49","Z87.19","Z83.719","Z80.3","Z80.0","S52.501","S52.614","S82.852","G43.909","M25.50","G89.29","K58.9","K76.0","R00.2","R94.31","M47.817","M25.531","Z51.89","E11.9","M65.98","Z79.1","Z79.85","Z78.0","R74.8","S93.432","Z79.620","Z68.34","M46.1","E56.9","D64.9","S52.571","E66.811","R11.0","E11.40","R06.00","M54.50","M79.601","M47.22","J80","F41.0","R10.84","G95.9","R55","Z12.11","K21.00","I34.1","I36.1","K62.1","K64.8","K64.4","K44.9","K29.50","K31.7","N95.9","M53.86","M54.2","Z12.31","G89.18","H53.8","N28.9","M65.4","M72.2","K29.60","K63.5","M67.431","E78.00","R73.03","M25.571","M65.331","M76.71","N28.89","D17.9","S82.832","E89.41","F32.A","Z79.4","N95.8","R91.8","R44.1","G40.89","I49.3","I49.8","I23.1","M79.602","M79.604","M79.605","E66.813","Z68.41","K76.89","Z00.00","F33.0","M54.59","S82.62X","M79.641","E11.65","E16.2","R13.19","R68.2","N61.1","M51.26","K20.90","S82.892","I67.89"],"date":["2026-01-09","2024-05-01","2024-05-01","2026-03-16","2026-03-16","2026-03-16","2026-01-05","2024-12-16","2025-12-30","2026-03-20","2025-08-04","2025-10-22","2026-02-17","2026-02-17","2025-07-21","2025-07-21","2026-02-17","2025-08-28","2026-02-17","2026-02-17","2025-04-22","2025-07-01","2025-03-24","2025-06-27","2025-04-22","2025-07-01","2025-03-24","2026-01-05","2025-05-20","2025-04-21","2026-01-07","2025-09-23","2025-08-28","2024-12-05","2025-06-03","2024-10-03","2026-01-23","2025-09-11","2026-01-07","2026-01-07","2026-01-09","2026-01-14","2026-01-14","2026-01-14","2025-02-17","2025-01-13","2024-09-29","2024-12-11","2024-09-29","2024-09-29","2026-02-06","2024-09-29","2024-09-29","2024-09-29","2024-09-29","2024-10-01","2024-09-29","2024-12-11","2025-08-28","2025-08-28","2025-11-07","2025-02-04","2025-04-03","2025-04-03","2025-04-21","2025-10-20","2025-12-30","2025-07-15","2024-11-22","2025-08-25","2025-10-10","2026-02-17","2026-02-17","2026-02-17","2026-02-17","2025-09-02","2025-10-20","2025-08-28","2025-06-27","2025-06-27","2026-01-14","2023-09-19","2023-11-13","2025-07-21","2024-10-08","2025-06-26","2026-02-15","2025-03-31","2024-11-19","2024-03-28","2023-12-10","2024-09-29","2024-09-29","2025-09-23","2024-08-14","2024-10-11","2024-12-11","2024-12-11","2024-10-24","2024-10-24","2024-12-11","2024-12-11","2024-12-11","2024-12-11","2024-12-11","2024-12-11","2024-12-04","2024-10-30","2024-10-30","2026-03-13","2025-06-27","2025-03-13","2025-12-09","2025-11-07","2025-11-07","2024-12-11","2024-12-11","2026-02-17","2025-12-30","2025-12-30","2024-08-23","2024-08-23","2024-08-23","2025-12-01","2025-12-09","2025-06-21","2026-02-06","2026-02-06","2026-02-06","2025-02-06","2024-09-29","2025-09-11","2025-09-11","2024-09-30","2024-09-30","2024-09-30","2024-03-28","2024-03-28","2024-03-28","2026-01-07","2026-01-07","2025-10-20","2025-12-30","2025-12-30","2024-05-06","2025-06-25","2026-02-04","2026-03-20","2026-03-20","2026-03-20","2026-03-20","2023-06-12","2024-04-05","2024-12-11","2025-06-21","2024-04-05"],"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":[["","","Escitalopram","10 MG","","Select","Select",""],["","","Diclofenac Sodium","75 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Amitriptyline Hydrochloride","25 MG","","Select","Select",""],["","","Baclofen","20 MG","","Select","Select",""],["","","Metoprolol Tartrate","50 MG","","Select","Select",""],["","","Pregabalin","150 MG","","Select","Select",""],["","","Pantoprazole","20 MG","","Select","Select",""],["","","1 Ml Erenumab-Aooe","140 MG","","Select","Select",""],["","","Rizatriptan","10 MG","","Select","Select",""],["","","Oxycodone\/Acetaminophen","","","Select","Select",""],["","","Cyanocobalamin","","","Select","Select",""],["","","Progesterone","100 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Mounjaro","","","Select","Select",""],["","","24 Hr Bupropion Hydrochloride","300 MG","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Albuterol Sulfate Hfa","","","Select","Select",""],["","","Levothyroxine Sodium","0.1 MG","","Select","Select",""],["","","Vitamin B12","1 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 Mg","","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Amox-Clav 875-125 Mg Tablet","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Hydrocodone\/Acetaminophen","","","Select","Select",""],["","","Hyoscyamine Sulfate","0.125 MG","","Select","Select",""],["","","Naproxen","500 MG","","Select","Select",""],["","","Meclizine Hydrochloride","25 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Cyanocobalamin 1,000 Mcg\/Ml Vl","","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Topiramate","50 MG","","Select","Select",""],["","","84 Hr Estradiol","0.00313 MG","","Select","Select",""],["","","Rimegepant","75 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 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":""}]}]}