{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard Maxwell Penn","gend":0,"currentgend":"","add":"304 E Breckinridge","city":"Macon","state":"GA","zip":31210,"dob":"1979-07-11","age":"","mstatus":"","insh":"0005782830001","cliId":"","pno":9124014430,"cno":9124014430,"email":"rmpenn12@yahoo.com","ename":"","eno":"","pphy":"Susan Debey","ppno":4786338700,"pcpadd":"240 SHERATON BLVD","pcpcity":"MACON","pcpstate":"GA","pcpzip":31210,"pcpcounty":"","pcpid":"","pcpname":"240 SHERATON BLVD","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"304 E Breckinridge","madd2":"","madd3":"","mcity":"Macon","mstate":"GA","mzip":31210,"pcpfaxno":4786338710,"pcpnpi":1619281680,"currentgendcomment":"","pphycomment":"","uniqueid":347686,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.11","Z88.0","Z88.8","Z87.891","M25.562","R74.8","Z89.512","Z00.00","E78.5","I10","K21.9","R41.3","G62.9","Z13.31","E55.9","L82.1","L81.4","D18.01","G54.6","G89.4","Z79.891","K74.60","R73.03","Z23","F17.210","F10.10","L97.922","I73.9","E53.8","Z79.899","R79.89","I77.6","D68.9","G47.00","I99.9","R41.89","G31.84","R11.10","N35.011","N35.010","N30.01","B96.89","R79.9","S81.812","W18.30X","M25.569","Z51.81","Z87.39","R51.9","M54.2","S19.9XX","K76.0","R16.0","M06.9","R11.0","M25.561","N50.819","R74.01","Z09","R41.0","I70.201","T18.2XX","R01.1","I70.262","N35.919","M19.90","G89.29","Z86.718","Z79.82","Z79.01","Z80.0","N50.811","N50.812","I86.1","E86.0","R26.9","N52.03","S00.83X","V00.811","K82.0","Z12.11","R05.8","S09.90X","T14.8XX","R10.0","Z12.12","Z78.9","M25.50","M87.051","E66.811","Z71.3","Z68.31","K21.00","R11.2","R05.9","K22.89","K20.90","K31.89","L72.0","R31.29","M06.00","R94.5"],"date":["2024-09-26","2024-09-26","2024-09-26","2024-11-09","2025-03-10","2025-02-07","2025-11-13","2025-12-03","2025-12-03","2025-12-03","2025-12-03","2025-04-08","2025-12-03","2025-12-03","2025-12-03","2026-03-09","2026-03-09","2026-03-09","2024-11-14","2025-05-15","2023-11-08","2025-12-03","2025-12-03","2025-12-03","2025-12-03","2025-12-03","2025-01-06","2025-11-13","2025-06-09","2025-06-09","2024-08-28","2024-06-04","2023-06-05","2023-06-05","2025-04-02","2025-03-18","2025-03-18","2024-08-27","2025-10-21","2025-10-21","2025-10-21","2025-10-21","2024-01-05","2024-12-04","2024-12-04","2025-03-10","2025-03-10","2025-04-07","2025-03-13","2025-03-13","2025-03-13","2024-12-10","2024-10-03","2023-12-06","2023-12-22","2025-03-10","2024-11-09","2024-11-20","2024-11-20","2024-11-20","2024-02-12","2024-02-12","2024-02-12","2024-02-12","2024-02-12","2024-02-12","2024-02-12","2024-02-12","2024-02-12","2024-08-27","2024-02-12","2024-11-09","2024-11-09","2024-11-09","2024-10-24","2025-08-18","2025-10-21","2025-03-13","2025-03-13","2024-09-26","2025-10-22","2024-08-27","2025-04-08","2024-12-05","2024-09-26","2025-10-22","2025-05-15","2025-04-07","2025-04-07","2025-12-16","2025-12-16","2025-12-16","2024-02-12","2024-02-12","2024-02-12","2024-02-12","2024-02-12","2024-02-12","2024-06-27","2024-09-30","2025-03-10","2023-12-22"],"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":[["","","Amlodipine","5 MG","","Select","Select",""],["","","Rivaroxaban","20 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","10 MG","","Select","Select",""],["","","Gabapentin","600 MG","","Select","Select",""],["","","Eszopiclone","2 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Lisinopril","40 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Fenofibrate","145 MG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Alprazolam","0.5 MG","","Select","Select",""],["","","Lactulose","10 GM","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Icosapent Ethyl","1000 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Promethazine Hydrochloride","25 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Oxycodone Hcl Ir","5 MG","","Select","Select",""],["","","Tadalafil","5 MG","","Select","Select",""],["","","Famotidine","20 MG","","Select","Select",""],["","","Trazodone Hydrochloride","100 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":""}]}]}