{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William Allen Bass","gend":0,"currentgend":"","add":"1330 US Highway 319 N Lot 112","city":"Norman Park","state":"GA","zip":31771,"dob":"1963-07-13","age":"","mstatus":"","insh":"0005281203002","cliId":"","pno":2293195569,"cno":"","email":"tkbass93@yahoo.com","ename":"","eno":"","pphy":"Jessica Mitchum","ppno":2295029769,"pcpadd":"3131 S MAIN ST","pcpcity":"MOULTRIE","pcpstate":"GA","pcpzip":31768,"pcpcounty":"","pcpid":"","pcpname":"3131 S MAIN ST","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"1330 US Highway 319 N Lot 112","madd2":"","madd3":"","mcity":"Norman Park","mstate":"GA","mzip":31771,"pcpfaxno":2299853751,"pcpnpi":1629510912,"currentgendcomment":"","pphycomment":"","uniqueid":374440,"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":["I10","E11.9","I25.110","E78.1","E78.2","I48.0","F17.210","Z96.651","L98.8","F32.5","F41.1","F43.10","J96.01","E11.22","I13.0","I50.32","N18.1","E11.65","G47.33","K21.9","E66.01","R42","I95.9","R10.9","R53.1","R53.83","R11.2","R05.8","Z79.85","Z68.38","Z99.89","Z79.899","F32.1","F43.12","F13.20","I11.0","I38","G89.18","M54.16","R94.5","Z79.01","Z95.9","Z68.37","Z28.310","Z72.0","M25.561","M25.562","G89.29","I35.1","R94.31","R94.39","R06.00","R00.2","R06.02","Z98.890","Z95.5","M17.11","L57.0","L30.8","I87.2","L40.8","B35.4","M53.86","M54.59","M24.28","M79.604","M54.9","M54.6","M54.50","L30.9","F32.4","M54.89","R53.82","R06.09","R07.9","I25.10","Z68.41","Z75.1","R60.0","I20.89","L92.0","L40.0","R07.2","R11.0","E88.810","B35.6","H93.13","H91.93","E66.812","I34.0","I07.1","M54.12","Z79.891","R09.81","R05.9","J18.9","J44.1","I11.9","E78.5","I45.10","M31.6","I25.119","D18.01","H90.3","I50.9","L76.82","M51.369","Z51.81","M50.30","R51.9","R94.30","L82.1","L81.4","L82.0","D22.9","M79.605","R21","D22.5","L91.8","M67.449","I73.9","Z09","R10.13","Z76.0","Z47.1","Z01.811","R60.9"],"date":["2026-01-08","2026-01-08","2026-01-26","2026-01-26","2026-01-08","2026-01-08","2026-01-27","2024-03-21","2025-10-06","2023-08-03","2023-11-30","2024-12-22","2025-01-02","2024-12-22","2024-12-22","2026-01-26","2024-12-22","2024-12-22","2025-07-29","2026-01-08","2025-04-01","2024-12-22","2024-12-22","2024-12-22","2024-12-22","2024-12-22","2024-12-22","2024-12-22","2024-12-22","2025-10-01","2024-12-22","2026-01-27","2024-06-11","2026-01-08","2024-06-11","2023-10-03","2025-05-07","2023-10-03","2026-01-27","2023-10-03","2026-01-27","2023-10-03","2023-10-03","2023-10-03","2023-10-03","2025-08-29","2023-09-19","2025-10-01","2026-01-26","2025-04-01","2025-04-01","2025-04-01","2025-04-01","2026-01-08","2025-04-01","2025-07-29","2023-10-02","2025-07-02","2025-01-21","2025-07-29","2025-01-21","2025-08-28","2025-08-28","2025-10-01","2025-08-28","2025-08-29","2025-08-29","2025-08-29","2025-08-29","2025-10-08","2024-06-12","2026-01-08","2026-01-08","2024-11-25","2025-04-01","2025-03-25","2025-03-24","2025-04-01","2023-10-04","2024-12-22","2026-01-05","2026-01-05","2024-11-25","2024-12-20","2024-03-01","2025-10-01","2025-12-04","2025-10-01","2025-10-01","2025-07-29","2025-07-29","2026-03-05","2025-12-11","2023-06-02","2023-10-04","2023-06-02","2023-06-02","2023-03-31","2023-03-31","2026-01-26","2023-07-12","2025-04-01","2026-01-05","2025-12-04","2023-07-12","2023-10-04","2025-11-18","2023-07-06","2025-11-20","2023-07-07","2025-04-01","2026-01-05","2026-01-05","2025-05-06","2025-05-06","2025-01-24","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2023-07-12","2025-01-02","2025-01-02","2026-01-27","2023-10-02","2025-03-25","2023-10-04"],"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":[["","","Metformin Hydrochloride","500 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","50 MG","","Select","Select",""],["","","Fenofibrate","145 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Eliquis","5 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Clopidogrel","75 MG","","Select","Select",""],["","","Icosapent Ethyl","1000 MG","","Select","Select",""],["","","Omega-3 Acid Ethyl Esters Usp","1000 MG","","Select","Select",""],["","","Ropinirole","0.5 MG","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","Gemfibrozil","600 MG","","Select","Select",""],["","","24 Hr Diltiazem Hydrochloride","360 MG","","Select","Select",""],["","","Buspirone Hydrochloride","15 MG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Jardiance","25 MG","","Select","Select",""],["","","24 Hr Isosorbide Mononitrate","120 MG","","Select","Select",""],["","","12 Hr Bupropion Hydrochloride","150 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 5-325","","","Select","Select",""],["","","12 Hr Ranolazine","1000 MG","","Select","Select",""],["","","Divalproex Sodium","250 MG","","Select","Select",""],["","","Ventolin Hfa","90 MCG","","Select","Select",""],["","","Mounjaro","5 MG","","Select","Select",""],["","","Metoclopramide","10 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Tizanidine","6 MG","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Clobetasol Propionate","0.0005 MG","","Select","Select",""],["","","Losartan Potassium","50 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","10 MG","","Select","Select",""],["","","Journavx","","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Clonazepam","0.5 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Clotrimazole","10 MG","","Select","Select",""],["","","Ketoconazole","","","Select","Select",""],["","","Econazole Nitrate","10 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":""}]}]}