{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah Sienkiewicz","gend":1,"currentgend":"","add":"250B Midway Rd","city":"Athens","state":"GA","zip":30605,"dob":"1961-09-30","age":"","mstatus":"","insh":"0005000335001","cliId":"","pno":7063956548,"cno":7063956548,"email":"gesienk63@gmail.com","ename":"","eno":"","pphy":"Afoma King","ppno":4027179600,"pcpadd":"3320 OLD JEFFERSON RD BLDG 200","pcpcity":"ATHENS","pcpstate":"GA","pcpzip":30607,"pcpcounty":"","pcpid":"","pcpname":"3320 OLD JEFFERSON RD BLDG 200","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"250B Midway Rd","madd2":"","madd3":"","mcity":"Athens","mstate":"GA","mzip":30605,"pcpfaxno":4027176014,"pcpnpi":1467890889,"currentgendcomment":"","pphycomment":"","uniqueid":374078,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M46.1","R41.89","G93.41","J96.21","J96.22","N17.0","E87.1","E86.1","I48.0","J44.1","F32.A","I10","E87.4","J98.11","E78.5","E87.5","F17.210","F41.9","G89.29","I95.2","T50.915","K21.9","Z79.82","Z86.74","Z79.899","J96.01","R65.21","N17.9","J90","F33.42","H01.00B","E55.9","M47.816","A41.9","J18.9","J69.0","J91.8","J44.0","Z11.52","I25.10","R13.14","R06.00","I48.91","R91.8","I21.A1","E86.0","I11.0","I50.30","E83.42","E87.6","Z78.1","Z79.01","Z80.9","Z84.1","G92.8","J96.02","J15.9","I95.9","F11.10","B19.20","D64.9","T40.601","Z79.51","Z79.891","Z82.49","G89.4","E78.00","J44.9","F32.0","G60.9","M51.36","M54.12","M54.16","R57.0","M25.512","E87.20","I50.32","S00.03X","S16.1XX","Z86.73","F11.93","R05.9","K80.20","K57.30","M54.2","J98.4","M50.30","M19.071","Z98.1","Z96.643","M79.622","Z96.612","M25.551","M47.818","Z96.641","S19.9XX","R41.82","R50.9","Z09","R23.3","B18.2","R13.19","Z72.0","R11.2","Z00.00","R68.89","R07.9","M79.671","M16.12","R13.10","M79.18","B37.0","Z12.31","R39.9","Z13.31","R91.1","F11.90","J30.89","M51.34","M48.56X","M47.26","M99.73","Z13.6","Z74.09","M25.552","R41.3","H53.2","H25.13","H50.10","R57.9","Z86.19","J16.8","M47.817","M51.35","J96.00","R05.8","E87.21","I49.9","M79.89","M54.17","Z13.811"],"date":["2025-11-26","2025-12-17","2025-08-19","2023-11-09","2023-11-09","2023-11-09","2025-05-16","2025-08-19","2025-08-19","2025-04-02","2025-08-19","2025-06-23","2023-12-04","2025-04-06","2025-06-23","2025-04-02","2025-08-19","2025-08-19","2025-08-19","2023-11-09","2023-11-09","2026-02-03","2025-05-16","2023-11-09","2025-08-19","2025-08-20","2025-08-19","2025-08-19","2025-04-24","2025-06-23","2025-01-14","2025-06-23","2025-01-14","2025-08-19","2025-08-19","2025-04-02","2025-04-02","2025-08-19","2025-04-02","2025-05-18","2025-05-01","2025-05-16","2025-05-18","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2023-12-04","2023-12-04","2025-08-20","2023-12-05","2023-12-04","2023-12-04","2023-12-04","2023-12-04","2023-12-04","2026-01-22","2025-05-16","2026-01-22","2024-02-28","2025-08-20","2024-02-28","2024-02-28","2024-02-28","2025-06-09","2026-01-22","2023-11-13","2024-04-18","2025-05-18","2025-05-18","2025-05-16","2025-05-16","2025-05-16","2023-10-04","2025-08-19","2025-08-19","2025-08-19","2026-01-22","2025-04-07","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-03-17","2025-09-03","2025-03-17","2025-03-17","2025-05-16","2025-08-19","2025-08-19","2025-04-14","2025-04-14","2026-02-03","2025-04-14","2025-06-23","2025-05-18","2025-01-07","2025-01-07","2025-08-19","2025-05-08","2024-03-21","2025-08-13","2025-10-01","2025-01-07","2025-01-07","2025-01-07","2025-01-07","2024-03-07","2024-03-07","2024-03-07","2024-01-06","2024-01-06","2024-01-06","2024-01-06","2025-08-19","2025-05-18","2023-04-11","2025-06-23","2023-03-29","2023-03-29","2023-03-29","2025-08-22","2024-02-28","2025-04-02","2026-02-24","2025-05-16","2023-12-04","2023-12-04","2023-11-11","2025-04-02","2025-04-24","2024-12-02","2025-05-01"],"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":[["","","Cefdinir","300 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Oxycodone\/Acetaminophen","","","Select","Select",""],["","","Aripiprazole","10 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Pregabalin","100 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 10-325","","","Select","Select",""],["","","Celecoxib","100 MG","","Select","Select",""],["","","Hydroxyzine Hcl","25 MG","","Select","Select",""],["","","Valsartan","160 MG","","Select","Select",""],["","","Albuterol Sul","2.5 MG","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Mirtazapine","15 MG","","Select","Select",""],["","","24 Hr Bupropion Hydrochloride","150 MG","","Select","Select",""],["","","Oxycodone-Acetaminophn 7.5-325","","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Nystop 100,000 Unit\/Gm Powder","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Nystatin 100000 Unt\/Ml Oral Suspension","","","Select","Select",""],["","","Fluticasone Propionate","0.05 MG","","Select","Select",""],["","","Trelegy Ellipta 100-62.5-25","","","Select","Select",""],["","","Hydrocodone-Acetamin 10-325 Mg","","","Select","Select",""],["","","Nystatin 100000 Unt\/Ml Topical Cream","","","Select","Select",""],["","","Albuterol Sulfate Hfa","","","Select","Select",""],["","","Fluconazole","100 MG","","Select","Select",""],["","","Sulfacetamide Sodium","100 MG","","Select","Select",""],["","","Budesonide\/Formoterol Fumarate Dihydrate","","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Carvedilol","3.125 MG","","Select","Select",""],["","","Hydralazine Hydrochloride","25 MG","","Select","Select",""],["","","Losartan Potassium","100 MG","","Select","Select",""],["","","Lorazepam","0.5 MG","","Select","Select",""],["","","Lidocaine","25 MG","","Select","Select",""],["","","0.5 Ml Respiratory Syncytial Virus Pre-Fusion F Protein, Recombinant","0.24 MG","","Select","Select",""],["","","0.5 Ml Influenza A Virus A\/Darwin\/11\/2021 H3N2 Antigen","0.03 MG","","Select","Select",""],["","","Nystatin 100 Unt\/Mg Topical Powder","","","Select","Select",""],["","","Clotrimazole","","","Select","Select",""],["","","Trelegy Ellipta","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Nicotine Transdermal System","","","Select","Select",""],["","","Mavyret","","","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":""}]}]}