{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michelle Reynolds","gend":1,"currentgend":"","add":"4768 Sherman Allen Rd","city":"Gainesville","state":"GA","zip":30507,"dob":"1979-04-27","age":"","mstatus":"","insh":"0005705550002","cliId":"","pno":6788586472,"cno":6788586472,"email":"cmr81972@gmail.com","ename":"","eno":"","pphy":"Kathryn Dudas","ppno":7705342800,"pcpadd":"3641 THOMPSON BRIDGE RD","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":30506,"pcpcounty":"","pcpid":"","pcpname":"3641 THOMPSON BRIDGE RD","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"4768 Sherman Allen Rd","madd2":"","madd3":"","mcity":"Gainesville","mstate":"GA","mzip":30507,"pcpfaxno":7705342889,"pcpnpi":1164683058,"currentgendcomment":"","pphycomment":"","uniqueid":342630,"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":["R55","D32.9","R41.82","M54.2","F10.229","F41.1","F33.1","F43.12","R07.9","R79.1","F10.20","M25.511","M79.601","R53.1","M54.12","D49.6","E55.9","F10.10","K21.9","Z63.0","Z86.011","Z87.891","Z79.899","F41.9","R51.9","R26.89","R29.3","R26.81","M62.81","R29.898","R41.842","F17.290","Z12.31","E43","R56.9","F32.9","Z68.1","Z71.3","F43.10","D72.829","T38.0X5","Z98.82","F10.11","F90.0","F33.2","F10.90","D33.1","G93.89","M79.645","W54.0XX","M25.512","Z98.890","F41.0","M19.90","T36.0X5","T36.1X5","T45.0X5","R00.1","R47.9","I10","H61.21","Z00.00","Z20.822","Z11.4","N95.1","E04.1","F10.21","K29.00","E46","R03.0","F12.10","G47.00","Z86.73","Z91.410","Z68.20","Z12.11","D12.2","D12.4","K57.30","Z98.0","K63.5","J18.9","S13.9XX","E04.2","M72.2","S61.353","M47.812","F41.8","G89.4","I95.1","R41.840","R41.3","R41.844","R41.841","R41.89","H53.8","R13.10","G45.9","R21","R63.6","S39.92X","S19.9XX","S29.9XX","Z09","H69.93","R42","R06.83","C71.9","R04.2","R05.1","R06.02","R09.89","H53.2","R49.0","K29.20","F10.129","J30.9","R09.81","R09.82","F32.2","F10.239","G47.33","F33.9","T50.905","Z13.6","S61.258","A60.00","B02.7","Z11.59","D35.9","D32.0","I61.9","J30.89","Z01.89","Z30.41","K51.00"],"date":["2025-02-26","2026-01-07","2025-02-27","2024-11-27","2025-05-12","2026-03-04","2026-03-04","2025-05-12","2024-09-21","2023-08-27","2025-11-26","2024-11-27","2024-11-27","2024-11-27","2026-03-05","2025-04-17","2025-02-27","2026-03-04","2025-02-27","2026-03-04","2025-02-27","2025-02-27","2025-02-27","2025-08-26","2024-10-08","2025-04-17","2024-12-30","2024-12-30","2025-04-17","2025-01-24","2024-12-30","2025-05-31","2024-12-10","2024-10-25","2024-10-25","2024-10-25","2025-08-26","2024-10-25","2025-06-05","2024-10-25","2024-10-25","2024-10-25","2026-03-04","2026-03-04","2025-11-26","2025-06-05","2024-10-28","2024-10-27","2024-10-14","2024-10-21","2024-07-23","2024-10-26","2026-03-04","2023-08-27","2024-10-13","2024-10-13","2024-10-13","2024-10-13","2025-02-27","2025-05-14","2026-02-04","2024-12-10","2023-12-06","2023-12-06","2026-02-11","2024-08-01","2024-06-11","2023-12-06","2025-08-26","2024-09-11","2025-05-31","2026-01-20","2025-05-31","2025-11-24","2026-02-11","2025-05-14","2025-05-14","2025-05-14","2025-05-14","2025-05-14","2025-05-14","2023-10-09","2024-06-18","2024-08-01","2025-11-26","2024-10-21","2026-02-18","2026-02-18","2026-02-18","2024-09-21","2025-04-17","2025-04-17","2025-04-17","2025-04-17","2025-04-17","2025-04-17","2024-10-28","2025-02-27","2024-09-11","2024-12-10","2023-05-28","2023-05-28","2023-05-28","2025-03-04","2026-02-04","2026-02-04","2024-06-11","2024-09-21","2023-08-27","2023-08-27","2023-08-27","2023-08-01","2024-10-13","2023-08-01","2025-05-28","2025-05-28","2023-10-03","2023-10-03","2023-10-03","2025-12-12","2025-05-30","2026-01-20","2026-01-20","2024-10-13","2024-10-13","2024-10-08","2024-06-11","2023-02-22","2023-12-06","2025-06-20","2024-10-25","2024-10-25","2023-10-09","2024-06-11","2024-06-11","2024-06-11"],"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":[["","","Valacyclovir","1000 MG","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Dextroamp-Amphet Er","10 MG","","Select","Select",""],["","","Prednisone","50 MG","","Select","Select",""],["","","Hydroxyzine Hydrochloride","25 MG","","Select","Select",""],["","","Acetaminophen","300 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Dexamethasone","4 MG","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","Vortioxetine","20 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Prazosin","1 MG","","Select","Select",""],["","","Hydroxyzine Pamoate","","","Select","Select",""],["","","Trazodone Hydrochloride","50 MG","","Select","Select",""],["","","Doxepin","10 MG","","Select","Select",""],["","","Buspirone Hydrochloride","10 MG","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","Junel","1 MG","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Clonazepam","0.5 MG","","Select","Select",""],["","","0.5 Ml Bordetella Pertussis Filamentous Hemagglutinin Vaccine, Inactivated","0.016 MG","","Select","Select",""],["","","Oxycodone Hydrochloride","5 MG","","Select","Select",""],["","","Levetiracetam","500 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Magnesium Sulfate","225 MG","","Select","Select",""],["","","Naltrexone Hydrochloride","50 MG","","Select","Select",""],["","","Risperidone","1 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":""}]}]}