{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gina Scharf","gend":1,"currentgend":"","add":"132 Jus Base Way","city":"Dalton","state":"GA","zip":30721,"dob":"1980-01-06","age":"","mstatus":"","insh":"0005152912001","cliId":"","pno":7063132610,"cno":7063132610,"email":"dusti134134@yahoo.com","ename":"","eno":"","pphy":"Erick Kimmerling","ppno":7062261530,"pcpadd":"1200 MEMORIAL DR","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"1200 MEMORIAL DR","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"132 Jus Base Way","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":30721,"pcpfaxno":7062774215,"pcpnpi":1740262864,"currentgendcomment":"","pphycomment":"","uniqueid":343892,"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":["Z00.00","Z12.31","I10","G43.909","F39","G47.33","E66.01","Z68.43","Z79.899","I82.409","L91.8","E66.813","M79.641","Z20.828","J06.9","R01.1","I51.7","I82.432","S60.221","Z23","R05.9","J00","J20.9","J30.9","I34.1","I36.1","R01.2","Z86.718","Q20.8","Z12.11","Z12.12","Z01.411","Z87.42","N92.0","N94.5","E28.2","F33.42","G43.109","J30.89","R09.81","H65.192","Z03.818","Z11.52","I50.810","F32.A","G47.30"],"date":["2026-03-09","2026-03-09","2025-10-01","2024-02-29","2024-02-29","2025-11-25","2024-06-13","2025-11-25","2024-01-29","2023-08-01","2023-07-27","2025-11-25","2024-05-10","2025-02-17","2025-02-17","2025-10-01","2025-10-16","2023-08-01","2024-06-13","2024-09-28","2023-10-13","2023-10-13","2023-11-08","2023-10-13","2024-06-24","2023-02-02","2024-07-08","2025-07-14","2025-10-01","2025-07-08","2025-07-08","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2024-09-04","2024-09-04","2025-12-22","2025-12-22","2025-12-22","2023-11-08","2023-11-08","2024-01-15","2025-09-05","2024-02-21"],"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":[["","","Sertraline","50 MG","","Select","Select",""],["","","Bisoprolol Fumarate","10 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Topiramate","200 MG","","Select","Select",""],["","","Hydrochlorothiazide","","","Select","Select",""],["","","Sertraline Hydrochloride","","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","0.5 Ml Influenza A Virus A\/Darwin\/6\/2021 H3N2 Antigen","0.09 MG","","Select","Select",""],["","","Dextromethorphan Hydrobromide","3 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 5-325","","","Select","Select",""],["","","Methylprednisolone","4 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":""}]}]}