{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John B Stafford","gend":0,"currentgend":"","add":"350 Douthit Cir","city":"Crandall","state":"GA","zip":30711,"dob":"1964-09-07","age":"","mstatus":"","insh":"0005901132002","cliId":"","pno":7062643063,"cno":"7062643064","email":"","ename":"","eno":"","pphy":"Nimota Akintoye","ppno":4047521000,"pcpadd":"223 Medical Center Drive","pcpcity":"RIVERDALE","pcpstate":"GA","pcpzip":30274,"pcpcounty":"","pcpid":"","pcpname":"223 Medical Center Drive","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"350 Douthit Cir","madd2":"","madd3":"","mcity":"Crandall","mstate":"GA","mzip":30711,"pcpfaxno":4047561480,"pcpnpi":1295382182,"currentgendcomment":"","pphycomment":"","uniqueid":202684,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R41.3","F31.12","R45.1","F22","I10","Z79.899","Z79.82","R41.82","R45.851","R45.850","F12.90","E78.5","F20.9","F31.9","F39","F98.8","E29.1","I67.9","G45.9","G31.9","G24.01","Z12.11","Z00.00","E78.1","L60.3","F31.2","F12.10","N52.9","F15.11","G31.09","F02.80","G12.20","R73.9","F23","Z78.1","Z12.12","Q21.12","I63.9","R25.1","R44.3","Z86.73","E66.01","Z71.2","H40.013","H25.813","N50.812","F15.10","Z72.0","R44.1"],"date":["2024-04-12","2023-03-08","2023-03-08","2023-03-08","2026-02-13","2026-02-13","2023-03-08","2023-10-06","2023-03-08","2023-03-08","2023-03-08","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2025-11-12","2024-11-04","2025-05-07","2024-11-04","2025-11-12","2026-02-01","2025-05-07","2024-04-08","2025-11-12","2023-03-14","2023-03-14","2025-05-07","2025-05-07","2024-07-31","2024-06-04","2024-06-04","2023-05-16","2023-03-08","2023-03-08","2026-02-01","2023-09-14","2023-11-28","2024-04-12","2025-02-06","2023-03-14","2023-03-11","2023-03-11","2026-03-10","2026-03-10","2023-12-07","2023-03-06","2023-03-08","2023-04-14"],"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":[["","","Carvedilol","12.5 MG","","Select","Select",""],["","","Lisinopril","40 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Valbenazine","60 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Amphetamine Aspartate","2.5 MG","","Select","Select",""],["","","Quetiapine","100 MG","","Select","Select",""],["","","0.5 Ml Varicella Zoster Virus Glycoprotein E, Recombinant","0.1 MG","","Select","Select",""],["","","Dextroamp-Amphetamin","10 MG","","Select","Select",""],["","","Amphetamine\/Dextroamphetamine","","","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":""}]}]}