{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas Dalton","gend":0,"currentgend":"","add":"278 Lyllian Ln","city":"Dahlonega","state":"GA","zip":30533,"dob":"1965-03-13","age":"","mstatus":"","insh":"0005214877001","cliId":"","pno":2055153366,"cno":2055153366,"email":"t3dalton@yahoo.com","ename":"","eno":"","pphy":"Christopher Huckle","ppno":7708486190,"pcpadd":"1315 JESSE JEWELL PKWY NE STE 300","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":30501,"pcpcounty":"","pcpid":"","pcpname":"1315 JESSE JEWELL PKWY NE STE 300","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"278 Lyllian Ln","madd2":"","madd3":"","mcity":"Dahlonega","mstate":"GA","mzip":30533,"pcpfaxno":"","pcpnpi":1023400777,"currentgendcomment":"","pphycomment":"","uniqueid":372316,"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":["K42.9","H18.603","H25.13","H43.813","H52.213","Z79.899","I47.29","G47.33","G47.30","E78.00","E55.9","E46","I10","R00.1","Z12.5","Z00.00","M62.81","M75.21","R73.03","C61","Z13.89","E66.01","K63.5","K57.30","K64.0","S82.891","L81.4","L82.0","D18.01","R97.20","R00.2","I45.10","Z68.41","Z87.891","Z20.822","J02.0","R05.1","J10.1","Z68.35","R63.8","Z68.37","Z68.34","J06.9","Z68.38","R73.9","I77.819","E66.812","Z13.6","Z14.8","R93.5","K86.2","N42.89","Z12.11","Z86.010","D12.3","M25.562","H65.93","R14.0","S83.422","I45.19","I77.810","Z82.49","R55","M65.331","S99.911","M25.571","G57.81","Z68.39","Z91.038","Z68.36","G89.18","M25.511","Z83.3","E66.9","D73.4","K76.0","L82.1","L72.3","L23.7","L23.1","L23.9","L23.4","L23.2","L23.0","Z01.818","E66.09","G57.91","R74.8","N40.0","J40"],"date":["2024-08-29","2025-06-06","2025-06-06","2025-06-06","2024-06-04","2025-08-15","2025-12-12","2026-02-20","2025-09-22","2026-02-20","2024-06-20","2024-06-20","2026-02-20","2024-07-12","2026-02-20","2026-02-20","2024-07-18","2024-08-06","2026-02-20","2025-12-15","2024-03-25","2024-09-15","2024-04-25","2024-04-25","2024-04-25","2023-06-23","2025-09-15","2025-09-15","2025-09-15","2025-09-15","2024-11-25","2025-12-12","2024-09-15","2024-09-15","2024-12-22","2024-01-10","2024-01-10","2024-01-10","2024-08-29","2024-11-25","2025-12-12","2024-09-16","2024-12-22","2025-02-18","2025-11-18","2025-12-12","2025-12-12","2025-07-10","2025-11-18","2025-04-07","2025-05-05","2026-03-16","2024-04-25","2024-04-25","2024-04-25","2025-05-07","2025-05-13","2024-03-22","2025-05-07","2024-09-16","2024-09-16","2024-09-16","2023-05-17","2024-08-06","2023-05-28","2023-12-08","2023-12-08","2024-01-12","2026-02-20","2026-02-20","2024-08-14","2024-06-21","2023-08-09","2024-06-25","2025-05-05","2025-09-30","2025-09-15","2024-08-13","2025-09-15","2025-09-15","2025-09-15","2025-09-15","2025-09-15","2025-09-15","2024-08-05","2024-08-05","2024-01-12","2025-09-30","2025-06-26","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":[["","","Binaxnow Covid-19 Ag Self Test","","","Select","Select",""],["","","Irbesartan","150 MG","","Select","Select",""],["","","Rosuvastatin Calcium","20 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Benzonatate","200 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Oxycodone Hcl Ir","5 MG","","Select","Select",""],["","","Cephalexin","","","Select","Select",""],["","","Triamcinolone Acetonide","1 MG","","Select","Select",""],["","","Epinephrine","0.3 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","0.5 Ml Influenza A Virus A\/Darwin\/11\/2021 H3N2 Antigen","0.03 MG","","Select","Select",""],["","","Azithromycin","500 MG","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","Flucelvax Trival 2024-2025 Syr","","","Select","Select",""],["","","72 Hr Scopolamine","0.0139 MG","","Select","Select",""],["","","Dexcom G7 Sensor","","","Select","Select",""],["","","Levofloxacin","500 MG","","Select","Select",""],["","","Fluarix 2025-2026","","","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":""}]}]}