{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kaitlyn F Kohlmeier","gend":1,"currentgend":"","add":"4856 Town Creek Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"1999-11-23","age":"","mstatus":"","insh":"0004921584001","cliId":"","pno":7069681010,"cno":7624778475,"email":"kohlmeierkaitlyn@gmail.com","ename":"","eno":"","pphy":"Ramzi Ghosn","ppno":7062658002,"pcpadd":"73 PRESTIGE LN STE 103","pcpcity":"DAWSONVILLE","pcpstate":"GA","pcpzip":30534,"pcpcounty":"","pcpid":"","pcpname":"73 PRESTIGE LN STE 103","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"4856 Town Creek Rd","madd2":"","madd3":"","mcity":"Cleveland","mstate":"GA","mzip":30528,"pcpfaxno":7064290033,"pcpnpi":1407943301,"currentgendcomment":"","pphycomment":"","uniqueid":350167,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.605","M79.604","F39","Z11.3","Z00.00","Z13.89","F31.75","F90.0","R21","Z13.31","B37.31","J02.9","R10.A1","J06.9","H10.33","Z20.9","Z68.23","R11.2","R07.1","R06.02","R06.2","R91.8","F33.9","M79.601","L03.90","L51.1","M25.561","M25.562","L02.214","E53.8","N64.4","N39.0","R30.0","Z20.2","N76.1","R10.12","F33.8","Z20.822","R11.0","R10.9","R82.90","N30.01","R35.0","Z72.51","R30.9","R51.9","A64","R50.9","J11.1","H66.92","R05.1","Z68.22","E86.0","Z90.710","B37.9","Z11.8","Z79.899","E55.9","R10.84","F32.9","Z68.21","G43.009","R20.2","R53.1","H55.09","H53.8","L51.3","Z90.711","B34.9","F43.23","R53.83","R09.81","J02.0","R55","N20.0","M54.50","Z51.81","G43.109","F41.8","Z20.818","R10.31","Z87.42","L03.311","F43.22","R10.2","H65.192","Z68.1","R07.9","F31.81","F41.9","F98.8","F33.1","F43.10","N93.9","Z01.818","H93.11","F90.9","G51.0","R19.7","R60.0","L03.314","D72.829","N76.0","L03.818"],"date":["2025-07-03","2025-06-30","2025-09-12","2025-09-12","2025-10-27","2025-10-27","2026-02-04","2025-10-27","2025-10-27","2025-10-27","2023-04-28","2025-12-30","2025-12-30","2025-12-30","2025-12-30","2025-12-30","2026-01-13","2026-01-13","2025-08-29","2026-01-13","2025-08-29","2025-08-29","2025-07-09","2025-07-09","2025-07-09","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-05-09","2025-09-12","2025-05-14","2025-09-10","2024-05-09","2024-11-29","2025-05-02","2025-08-19","2025-08-19","2025-08-19","2025-09-10","2025-09-10","2025-09-10","2025-09-10","2025-09-10","2025-10-07","2025-04-15","2026-01-13","2026-01-13","2025-01-16","2025-05-22","2025-08-07","2023-04-28","2023-04-28","2023-03-30","2023-03-30","2025-02-03","2023-03-23","2025-04-04","2024-02-27","2024-02-27","2025-05-09","2025-03-05","2025-03-05","2025-03-05","2025-03-05","2025-10-07","2025-06-29","2025-05-22","2025-07-02","2025-08-29","2025-08-29","2024-12-27","2024-11-29","2024-03-02","2024-03-02","2025-02-03","2023-03-23","2023-03-23","2023-03-23","2025-04-11","2025-04-11","2025-06-29","2026-02-04","2025-09-10","2024-08-30","2024-08-30","2024-11-29","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2025-12-08","2023-04-19","2025-07-02","2024-07-06","2024-07-06","2024-07-06","2025-04-03","2025-07-01","2025-06-30","2025-06-30","2025-04-15","2025-07-01"],"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":[["","","Metronidazole","500 MG","","Select","Select",""],["","","Benzonatate","200 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Desvenlafaxine Er","","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Atomoxetine","25 MG","","Select","Select",""],["","","Lamotrigine","100 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Olanzapine","2.5 MG","","Select","Select",""],["","","Naproxen","500 MG","","Select","Select",""],["","","Famotidine","20 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Buspirone Hydrochloride","7.5 MG","","Select","Select",""],["","","Propranolol Hydrochloride","10 MG","","Select","Select",""],["","","Sumatriptan","100 MG","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Quetiapine","25 MG","","Select","Select",""],["","","Dicyclomine Hydrochloride","20 MG","","Select","Select",""],["","","24 Hr Amphetamine Aspartate","5 MG","","Select","Select",""],["","","Diclofenac Sodium","75 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Lisdexamfetamine Dimesylate","10 MG","","Select","Select",""],["","","Doxycycline Hyclate","","","Select","Select",""],["","","Ibuprofen","600 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Brompheniramine Maleate","0.4 MG","","Select","Select",""],["","","Fluoxetine","20 MG","","Select","Select",""],["","","Amox-Clav 875-125 Mg Tablet","","","Select","Select",""],["","","Cefdinir","300 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":""}]}]}