{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert Willoughby","gend":0,"currentgend":"","add":"136 Barber Rd","city":"Ray City","state":"GA","zip":"31645","dob":"1965-08-09","age":"","mstatus":"","insh":"0005303944001","cliId":"","pno":"2293002080","cno":"2295635310","email":"kimber6566@gmail.com","ename":"","eno":"","pphy":"ROBINA BELANGER","ppno":"3527351400","pcpadd":"1221 E MCPHERSON AVE","pcpcity":"NASHVILLE","pcpstate":"GA","pcpzip":"31639","pcpcounty":"","pcpid":"","pcpname":"1221 E MCPHERSON AVE","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"136 Barber Rd","madd2":"","madd3":"","mcity":"Ray City","mstate":"GA","mzip":"31645","pcpfaxno":"3527353300","pcpnpi":"1861631061","currentgendcomment":"","pphycomment":"","uniqueid":"350360","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":["F17.290","Z79.01","Z79.51","Z86.73","Z86.718","Z98.890","Z88.2","Z88.5","Z91.148","M79.621","K35.80","M79.605","G62.9","R60.9","I82.409","D50.9","N40.0","M48.061","S82.142","G12.21","J41.0","R09.02","J45.20","M79.89","M25.552","M25.562","W19.XXX","Y93.H2","K40.90","G47.33","R10.0","S80.02X","K35.30"],"date":["2026-06-22","2026-08-11","2026-01-30","2026-01-30","2026-01-30","2026-01-30","2026-01-30","2026-01-30","2026-01-30","2026-06-22","2026-01-28","2026-08-17","2026-08-17","2026-08-17","2026-08-17","2026-08-17","2026-07-29","2026-07-29","2026-08-11","2026-08-21","2026-08-21","2026-08-21","2026-08-21","2026-07-29","2026-08-11","2026-08-11","2026-08-11","2026-08-11","2026-05-05","2026-04-17","2026-01-28","2026-06-22","2026-01-28"],"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":[["","","TAMSULOSIN HYDROCHLORIDE","400 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50000 MG","","Select","Select",""],["","","PREDNISONE","20000 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":""}]}]}