{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carla Williams","gend":1,"currentgend":"","add":"601 E Orange St","city":"Fitzgerald","state":"GA","zip":31750,"dob":"1974-08-03","age":"","mstatus":"","insh":"0005867595001","cliId":"","pno":2294159361,"cno":2294159361,"email":"nikkigoodman74@gmail.com","ename":"","eno":"","pphy":"William Huffman","ppno":2298901442,"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":"601 E Orange St","madd2":"","madd3":"","mcity":"Fitzgerald","mstate":"GA","mzip":31750,"pcpfaxno":2298900782,"pcpnpi":1518149756,"currentgendcomment":"","pphycomment":"","uniqueid":343158,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K29.30","K44.9","R10.13","R11.2","E11.9","Z86.718","G25.81","G40.309","Z79.01","E87.6","N32.81","R13.19","I10","M79.7","F33.1","M32.8","N34.1","K21.9","Z12.31","E11.69","G60.3","R56.9","G43.019","G89.29","M54.81","L93.0","R76.8","Z79.899","E55.9","M06.4","K90.9","Z72.0","D50.9","R53.83","R51.9","Z86.711","M32.9","Z79.52","G56.02","J45.909","G40.909","M10.9","G47.33","F17.200","Z86.73","R53.1","N20.0","I63.89","G81.94","M79.642","M79.641","G43.909","F17.210","R31.9","M17.11","M17.12","R39.9","R10.9","N39.41","R10.11","R39.15","M45.9","R94.5","M1A.39X","G93.32","R73.9","R07.89","S40.012","E11.65","N73.6","Z90.710","T83.722","N39.46","T83.721","E11.43","K31.84","N39.0","R94.31","R07.9","R42","F12.10","Z68.37","N32.89","R13.10","R19.4","K29.70","T17.320","K64.1","Z12.11","D64.9","R13.14","R11.0","R40.0","R20.2","T38.3X5","G56.03","E11.8","G89.4","M17.0","J06.9","E66.01","Z68.36","G56.21","Z48.89","G89.18","M54.30","M19.90","Z90.49","Z80.9","Z82.49","S80.02X","M06.9","R82.81","N39.3","N36.41","T85.698","Z68.35","Z01.818","R10.2","R92.8","G56.22","I69.354","R47.81","E11.42","K29.50","F32.A","F41.9","Z87.442","Z87.440","Z83.3","Z95.5","Z79.84","R20.0","Z53.21","K29.80","R19.5","K64.8","Z80.0","I69.854","E66.9","Z79.51","Z88.1","Z88.0","K29.90","K22.2","F17.290","R06.00","R60.9","M50.13","I63.9","R06.2","I77.89","Z45.42","G83.84","G40.901","M62.81","Y82.8","Y93.9","Y92.9","Y99.9","R14.0","R06.09","Z63.0","I65.29","G81.90","N20.1","N89.8","R30.0","G40.A09","R12","W19.XXX","E61.1","M25.50","R82.71","Z13.89","J32.9","N99.89","R33.8","D64.89","K22.4"],"date":["2025-12-09","2025-12-30","2025-12-09","2025-12-09","2025-12-04","2023-09-26","2023-09-26","2023-09-26","2025-08-27","2025-11-15","2024-03-05","2023-09-26","2025-12-09","2023-09-26","2023-09-26","2023-09-26","2024-09-16","2025-09-02","2026-01-08","2026-01-15","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2025-12-11","2024-10-16","2024-10-16","2025-08-27","2024-10-16","2024-10-16","2024-10-16","2025-07-18","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2025-09-02","2025-08-27","2023-03-29","2025-08-14","2024-06-17","2023-03-29","2026-01-23","2025-04-23","2025-12-04","2025-12-11","2025-07-18","2024-06-17","2024-06-17","2024-06-17","2024-06-17","2025-07-24","2025-12-04","2024-01-29","2023-10-20","2023-10-20","2024-06-27","2024-02-19","2024-03-05","2024-09-10","2024-03-05","2024-04-03","2024-04-03","2024-04-03","2024-10-16","2024-04-03","2025-06-18","2025-03-31","2025-09-29","2024-09-10","2024-09-10","2024-09-10","2024-09-10","2024-09-10","2025-09-02","2025-09-02","2025-09-02","2025-10-31","2025-12-04","2025-10-31","2023-05-04","2023-07-13","2024-09-15","2025-09-29","2024-01-18","2025-12-30","2024-01-18","2024-01-18","2024-01-18","2024-01-18","2024-01-18","2025-09-05","2025-04-25","2025-12-11","2025-06-04","2025-02-25","2024-10-16","2024-10-16","2024-10-16","2026-02-03","2024-10-16","2024-04-03","2023-03-29","2024-09-16","2023-03-29","2024-06-12","2024-06-12","2024-06-12","2024-06-12","2024-06-12","2023-10-20","2023-06-27","2023-10-05","2024-09-10","2023-10-05","2023-10-05","2024-03-05","2024-08-28","2024-08-28","2026-02-17","2025-02-25","2023-06-13","2023-06-13","2023-06-08","2024-01-18","2023-06-13","2023-08-24","2023-06-08","2023-06-08","2023-06-08","2023-06-08","2024-03-05","2026-03-12","2026-03-12","2024-01-18","2024-01-18","2024-01-18","2024-01-18","2024-01-18","2024-01-18","2024-01-18","2024-01-18","2024-01-18","2024-01-25","2024-01-25","2025-11-15","2025-08-14","2025-08-14","2023-03-31","2024-06-12","2025-01-27","2023-06-08","2024-03-05","2023-06-13","2023-06-13","2023-06-13","2024-08-28","2024-08-28","2024-08-28","2024-08-28","2025-09-29","2025-08-21","2023-05-24","2025-12-04","2025-12-04","2023-08-04","2024-08-16","2024-08-16","2023-06-07","2025-12-09","2025-02-19","2025-08-27","2025-08-27","2024-09-16","2025-06-23","2025-04-23","2024-09-13","2024-09-13","2024-10-31","2023-10-24"],"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":[["","","Atorvastatin Calcium","","","Select","Select",""],["","","Mounjaro","","","Select","Select",""],["","","1.5 Ml Fremanezumab-Vfrm","150 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Losartan Potassium","25 MG","","Select","Select",""],["","","24 Hr Oxybutynin Chloride","10 MG","","Select","Select",""],["","","Acetaminophen-Cod #3 Tablet","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Lamotrigine","100 MG","","Select","Select",""],["","","Potassium Chloride","10 MEQ","","Select","Select",""],["","","Baclofen","10 MG","","Select","Select",""],["","","Levetiracetam","1000 MG","","Select","Select",""],["","","Zolmitriptan","2.5 MG","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Dicyclomine","10 MG","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Paroxetine Hydrochloride","20 MG","","Select","Select",""],["","","Hydralazine Hydrochloride","100 MG","","Select","Select",""],["","","0.5 Ml Influenza A Virus A\/Darwin\/9\/2021 H3N2 Antigen","0.03 MG","","Select","Select",""],["","","Ropinirole","0.5 MG","","Select","Select",""],["","","Eliquis","5 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Naproxen","500 MG","","Select","Select",""],["","","0.5 Ml Bordetella Pertussis Filamentous Hemagglutinin Vaccine, Inactivated","0.016 MG","","Select","Select",""],["","","{2","480 ML","","Select","Select",""],["","","Promethazine Hydrochloride","25 MG","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Rimegepant","75 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 Mg","","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Ibuprofen","600 MG","","Select","Select",""],["","","1 Ml Hepatitis A Vaccine Inactivated Strain Hm175 720 Unt\/Ml \/ Hepatitis B Surface Antigen Vaccine","0.02 MG","","Select","Select",""],["","","24 Hr Nifedipine","60 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 5-325","","","Select","Select",""],["","","Osmotic 24 Hr Nifedipine","60 MG","","Select","Select",""],["","","24 Hr Levetiracetam","500 MG","","Select","Select",""],["","","Comirnaty 2024-25(12Y Up) Syrg","","","Select","Select",""],["","","Benzonatate","100 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Cefuroxime","500 MG","","Select","Select",""],["","","Onetouch Delica Plus Lancets Fine","30 G","","Select","Select",""],["","","Onetouch Ultra","","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Sucralfate","1000 MG","","Select","Select",""],["","","Fluoxetine","20 MG","","Select","Select",""],["","","Gabapentin","600 MG","","Select","Select",""],["","","Warfarin Sodium","5 MG","","Select","Select",""],["","","Albuterol Sul","0.63 MG","","Select","Select",""],["","","Quetiapine","50 MG","","Select","Select",""],["","","Tamsulosin Hydrochloride","0.4 MG","","Select","Select",""],["","","Dicyclomine Hydrochloride","10 MG","","Select","Select",""],["","","0.5 Ml Sars-Cov-2 Covid-19 Vaccine, Mrna-1273 Omicron Xbb.1.5","0.1 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Vibegron","75 MG","","Select","Select",""],["","","Hydroxychloroquine Sulfate","200 MG","","Select","Select",""],["","","Duloxetine","30 MG","","Select","Select",""],["","","Pregabalin","50 MG","","Select","Select",""],["","","Flublok Trivalent 2024-25 Syrg","","","Select","Select",""],["","","Fluticasone Propionate","0.05 MG","","Select","Select",""],["","","Metoclopramide Hydrochloride","","","Select","Select",""],["","","Dexamethasone","6 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":""}]}]}