{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Shane Wells Story","gend":0,"currentgend":"","add":"130 Habersham Ct SE","city":"Calhoun","state":"GA","zip":30701,"dob":"1971-10-08","age":"","mstatus":"","insh":"0005406409001","cliId":"","pno":7069340414,"cno":7069340414,"email":"Shanestory82@yahoo.com","ename":"","eno":"","pphy":"Edward Arrowsmith","ppno":4236981844,"pcpadd":"1032 MCCALLIE AVE STE 200","pcpcity":"CHATTANOOGA","pcpstate":"TN","pcpzip":37403,"pcpcounty":"","pcpid":"","pcpname":"1032 MCCALLIE AVE STE 200","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"130 Habersham Ct SE","madd2":"","madd3":"","mcity":"Calhoun","mstate":"GA","mzip":30701,"pcpfaxno":4236242226,"pcpnpi":1780632687,"currentgendcomment":"","pphycomment":"","uniqueid":219028,"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":["K29.50","E78.5","I10","Z79.899","Z85.01","Z85.028","Z87.891","Z87.898","Z90.3","Z90.49","Z88.1","Z88.5","Z88.6","Z88.8","J30.89","K21.9","N40.0","R53.83","R79.89","K31.84","Z98.890","J45.909","C15.5","R07.81","R05.1","J01.00","Z76.0","K22.70","E66.9","Z86.16","K22.719","F33.0","M25.562","M25.571","M25.572","R23.3","L76.34","R26.2","F32.A","M79.642","L03.114","Z85.038","K31.89","K44.9","J44.9","K22.89","K43.2","M79.661","M79.89","R21","M25.561","K43.6","Z48.02","Z87.19","K22.10","K22.4","Q39.3","C15.9","I77.6","T80.69X","R73.9","T50.905","R11.2","Z09","R07.9","R10.9","J96.01","K66.0","Z68.41","E66.01","K22.711","Z80.9","K43.9","M79.81","C16.0","K22.2","R13.10","K29.60","Z12.11","K57.30","Z79.51","J20.9","R00.1","M10.072","K21.00","Z01.818","Z48.89","J98.11","Z68.35","R05.9","K43.0","N20.0","J42","Z68.36","R91.8","Z08","L03.311","S60.562","W57.XXX","R09.89","I51.7","K76.0","I49.8","K56.609","K40.20","K46.9","K29.70","K92.2","J93.83","K20.80","R60.0"],"date":["2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2024-04-23","2026-03-17","2024-04-23","2024-04-23","2024-04-23","2026-03-17","2025-10-15","2024-12-30","2025-12-16","2023-12-08","2026-02-25","2026-02-25","2026-02-25","2025-10-17","2024-10-10","2025-08-14","2025-07-17","2025-07-17","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-08-02","2025-08-02","2025-08-02","2023-07-25","2025-10-17","2023-12-22","2023-07-25","2026-03-03","2025-08-06","2025-08-06","2025-08-14","2025-08-14","2025-10-15","2025-10-15","2025-10-15","2024-02-26","2024-02-23","2024-02-23","2024-12-11","2025-08-14","2025-08-19","2025-08-14","2025-08-14","2025-09-30","2025-08-19","2023-09-05","2025-09-30","2025-09-30","2025-10-01","2023-09-11","2023-09-11","2025-12-15","2023-09-11","2024-11-05","2025-10-01","2023-09-18","2024-02-07","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-12-22","2023-05-19","2024-10-04","2024-07-26","2025-11-11","2025-11-03","2025-07-24","2023-10-04","2023-06-20","2023-11-27","2026-03-09","2025-12-15","2023-05-01","2023-05-01","2025-12-15","2025-11-04","2025-08-13","2025-08-05","2025-08-05","2026-03-09","2026-03-09","2024-08-07","2024-10-04","2025-09-30","2025-09-30","2025-09-30","2025-12-16","2025-12-16","2023-09-18","2024-02-23","2025-08-06"],"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":[["","","Sucralfate","1000 MG","","Select","Select",""],["","","Erythromycin","250 MG","","Select","Select",""],["","","Irbesartan","75 MG","","Select","Select",""],["","","24 Hr Bupropion Hydrochloride","150 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Mupirocin","","","Select","Select",""],["","","Oxycodone\/Acetaminophen","","","Select","Select",""],["","","Hydrocodone-Acetamin 7.5-325","","","Select","Select",""],["","","Metoclopramide","10 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Prednisolone Acetate","10 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Doxycycline Hyclate","","","Select","Select",""],["","","Celecoxib","100 MG","","Select","Select",""],["","","Oxycodone Hydrochloride","","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Vonoprazan","10 MG","","Select","Select",""],["","","Methocarbamol","500 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":""}]}]}