{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Damian Anthony Mroz","gend":0,"currentgend":"","add":"54 Cavender Ln","city":"Suches","state":"GA","zip":30572,"dob":"1966-09-30","age":"","mstatus":"","insh":"0004881302001","cliId":"","pno":3057610714,"cno":3057610714,"email":"mroz.damian84@gmail.com","ename":"","eno":"","pphy":"Alan Sanders","ppno":7067811966,"pcpadd":"401 PAT HARALSON DR UNIT 1","pcpcity":"BLAIRSVILLE","pcpstate":"GA","pcpzip":30512,"pcpcounty":"","pcpid":"","pcpname":"401 PAT HARALSON DR UNIT 1","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"54 Cavender Ln","madd2":"","madd3":"","mcity":"Suches","mstate":"GA","mzip":30572,"pcpfaxno":7067811968,"pcpnpi":1063478691,"currentgendcomment":"","pphycomment":"","uniqueid":366507,"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":["J96.01","E87.1","J91.8","J43.9","F17.210","Z87.01","R00.0","J86.9","S52.302","M86.132","L02.414","S63.592","D72.829","M19.012","I25.10","E78.2","S52.362","E83.42","I48.0","R79.82","R70.0","J90","J98.11","R09.02","R79.89","R79.1","E87.6","R64","M60.032","Z68.1","B95.4","R20.8","Z79.01","B99.9","Z68.20","D50.9","D72.825","E55.9","Z79.899","M84.434","Z87.39","S52.392","M21.372","R26.89","R29.898","M25.532","J44.9","J98.59","Z72.0","I38","D72.828","Z13.31","Z80.41","Z80.9","Z00.00","Z11.59","Z11.4","I49.3","L03.114","F17.200","Z91.89","J44.1","M79.632","Z98.890","Z48.813","J98.2","Z45.2","R91.8","I48.91","M86.032","J18.9","Z53.32","R84.6","M84.634","E78.5","Z28.21","Z53.20","Z01.818","G89.18","I96","M79.89","A49.1","J43.2","I10","Z87.891","Z46.82","J81.1","S52.342","M24.832","M25.332","M24.132","M75.82","M25.512","M75.42","L02.512","M86.9","S69.82X","M86.532","Z76.89","M79.602","R73.03","S52.592","S52.352","L03.116","J18.1","I33.0","R63.6","J15.9","M86.632","R22.31","J84.10","R22.32","R05.1","I16.0","L02.419","J94.8"],"date":["2023-05-30","2023-05-14","2023-05-30","2024-04-08","2024-06-05","2023-05-30","2023-05-14","2023-10-26","2026-03-16","2025-12-08","2024-07-01","2025-08-27","2025-02-13","2023-08-21","2025-09-10","2024-10-30","2024-04-01","2024-03-22","2025-12-08","2024-03-21","2024-05-29","2023-06-05","2023-05-08","2023-05-09","2023-05-09","2023-05-07","2023-05-09","2024-04-05","2025-06-19","2024-10-17","2024-04-05","2024-04-05","2024-04-05","2025-02-13","2026-03-16","2024-05-29","2024-03-19","2025-02-13","2024-06-13","2024-06-05","2024-07-01","2024-09-30","2024-09-30","2024-09-30","2024-08-16","2025-06-27","2024-03-06","2024-03-06","2024-03-17","2024-04-08","2024-10-30","2025-02-13","2024-10-30","2024-10-30","2024-12-18","2024-12-18","2024-12-18","2025-12-08","2024-09-11","2024-03-11","2024-05-09","2023-12-27","2024-09-30","2023-06-09","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2024-03-03","2025-02-13","2023-05-09","2023-05-30","2023-05-10","2024-04-05","2025-02-13","2024-12-18","2025-02-13","2025-08-26","2025-08-27","2024-03-18","2024-03-03","2024-04-09","2025-04-17","2025-04-17","2025-04-17","2023-05-14","2023-05-14","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2023-08-21","2023-08-21","2023-08-21","2024-03-18","2024-07-10","2025-07-28","2024-03-20","2024-07-10","2025-02-13","2025-02-13","2024-04-01","2025-05-16","2024-01-04","2023-05-07","2024-03-22","2024-09-11","2023-06-01","2024-06-05","2024-03-03","2023-07-12","2024-03-17","2024-01-04","2024-03-22","2024-03-17","2024-01-17"],"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":[["","","Prednisone","20 MG","","Select","Select",""],["","","Azithromycin","500 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Spiriva Respimat","2.5 MCG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Mupirocin","20 MG","","Select","Select",""],["","","Amiodarone Hydrochloride","200 MG","","Select","Select",""],["","","Metoprolol Tartrate","25 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Eliquis","5 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Ketorolac Tromethamine","10 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 Mg","","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Linezolid","600 MG","","Select","Select",""],["","","Oxycodone Hcl Ir","5 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 5-325","","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Budesonide","0.25 MG","","Select","Select",""],["","","Sulindac","200 MG","","Select","Select",""],["","","Morphine Sulfate Ir","15 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","10 MG","","Select","Select",""],["","","Oxycodone\/Acetaminophen","","","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":""}]}]}