{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tina Ricks","gend":1,"currentgend":"","add":"748 Bluebird Rd","city":"Moultrie","state":"GA","zip":31788,"dob":"1961-03-25","age":"","mstatus":"","insh":"0006155403001","cliId":"","pno":2297980463,"cno":"","email":"ricks_tina@yahoo.com","ename":"","eno":"","pphy":"Jonathan Cook","ppno":7063537747,"pcpadd":"702 SUNSET DRIVE SUITE 400A","pcpcity":"ATHENS","pcpstate":"GA","pcpzip":30606,"pcpcounty":"","pcpid":"","pcpname":"702 SUNSET DRIVE SUITE 400A","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"748 Bluebird Rd","madd2":"","madd3":"","mcity":"Moultrie","mstate":"GA","mzip":31788,"pcpfaxno":7063537756,"pcpnpi":1467443713,"currentgendcomment":"","pphycomment":"","uniqueid":384384,"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":["M70.61","M16.11","M25.551","M19.012","Z96.611","S40.011","S80.02X","I10","J45.909","E03.9","Z86.718","Z79.899","R10.9","E11.9","N17.9","N30.00","R11.0","I95.1","E86.0","J45.50","E78.2","F41.1","E11.69","R51.9","Z90.49","Z79.85","K43.6","J44.9","L98.7","F90.9","F31.9","E78.5","Z98.1","Z88.1","Z88.2","Z88.5","N39.0","Z79.84","Z01.818","M26.603","F90.8","K43.2","M25.451","K66.0","S31.109","T84.028","F98.8","M54.15","M54.6","B02.9","G62.89","M26.602","R68.84","Z11.52","M25.311","Z01.812","G89.18","Z51.89","I11.0","T78.3XX","T50.905","R06.02","R05.9","K80.20","E66.9","Z68.35","I50.9","R11.2","R94.4","E87.6","Z20.822","M62.81","D13.6","Z12.31","R92.323","Z12.11","D12.2","Z86.010","Z87.09","R10.11","K57.30","M25.512","Z98.890","Z87.19","T81.89X","S76.211","J45.901","M48.56X","M25.511","Z48.89","Z71.2","K63.5","T50.5X5","Z23","J44.1","Z41.9","M51.16","M51.35","R00.0","R11.10","R42","Z47.1","Z00.00","Z01.810","K46.9","J45.41","M25.412","G89.29","F41.8","M79.604","R60.0","M54.16","I82.409","Z98.84","Z68.26","J00","T81.30X","K80.10","M54.50","R53.83","Z13.21","M54.9","M51.360","K76.0","B34.9","Z09","T84.226","T81.41X","S76.011","K45.8","R10.0","K52.9","Z86.16","M47.26","M47.24","M48.061","Z87.81","S00.31X","S00.81X","T78.40X","R03.0","M24.411","E03.8","X58.XXX","Y93.9","Y92.9","M70.71","Z48.817","K80.00","H60.311","H92.01","K45.0","E66.3","Z68.28","K43.0","M54.51","T84.216","M54.59","Z48.02"],"date":["2026-02-04","2025-10-28","2026-01-07","2026-02-04","2025-05-21","2024-02-01","2024-02-01","2026-01-14","2024-07-31","2026-02-04","2024-04-03","2026-02-04","2024-08-16","2026-02-04","2025-09-22","2025-12-10","2025-09-22","2025-12-10","2025-12-10","2025-09-22","2026-01-14","2025-09-22","2025-09-22","2025-12-09","2025-09-22","2025-09-22","2023-09-13","2024-02-23","2023-09-13","2025-04-08","2025-04-08","2025-12-09","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2026-02-13","2026-02-04","2025-11-24","2025-03-17","2025-03-17","2023-08-23","2026-01-09","2023-10-24","2023-10-24","2024-04-02","2026-01-19","2025-03-25","2025-05-27","2024-01-24","2024-01-24","2025-02-28","2025-02-28","2025-07-31","2024-04-02","2025-11-24","2026-02-07","2026-01-19","2026-01-19","2026-01-19","2026-01-19","2026-01-17","2025-04-25","2024-08-08","2023-08-14","2023-02-28","2026-01-07","2025-01-23","2025-01-23","2026-02-13","2024-09-19","2025-09-04","2024-08-07","2025-06-18","2025-06-18","2024-11-20","2024-11-20","2024-11-20","2024-02-23","2024-08-07","2024-08-07","2026-01-13","2025-04-22","2025-03-27","2026-02-07","2026-02-04","2026-02-04","2025-04-07","2024-04-02","2026-02-07","2024-11-26","2024-11-26","2024-06-15","2025-05-20","2025-04-25","2025-04-02","2025-02-07","2025-04-13","2023-02-09","2023-02-09","2025-01-25","2024-10-11","2024-07-31","2025-11-24","2023-09-12","2025-04-25","2026-01-15","2026-01-07","2025-08-11","2026-01-07","2026-01-07","2026-01-07","2024-04-03","2025-03-27","2025-03-27","2025-11-07","2023-10-24","2024-08-09","2025-04-13","2025-09-04","2025-09-04","2025-01-03","2025-01-03","2023-02-09","2024-09-19","2025-02-10","2025-03-25","2024-08-16","2026-02-04","2024-01-17","2024-08-19","2023-02-09","2023-02-09","2025-02-07","2025-02-07","2025-02-07","2025-02-07","2024-02-01","2024-02-01","2026-01-17","2026-01-17","2024-03-27","2026-01-14","2026-01-27","2026-01-27","2026-01-27","2025-10-22","2023-12-01","2024-08-07","2024-07-10","2024-07-10","2023-09-13","2025-05-01","2025-05-01","2023-09-12","2025-01-14","2025-04-07","2025-01-03","2025-04-22"],"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":[["","","Mounjaro","12.5 MG","","Select","Select",""],["","","Fluoxetine Hydrochloride","","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Levothyroxine Sodium","0.112 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","Nabumetone","750 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Trelegy Ellipta","","","Select","Select",""],["","","Aripiprazole","5 MG","","Select","Select",""],["","","Amphetamine Aspartate","2.5 MG","","Select","Select",""],["","","Fluoxetine","40 MG","","Select","Select",""],["","","Fluticasone Propionate","0.05 MG","","Select","Select",""],["","","Amphetamine\/Dextroamphetamine","","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Acetaminophen\/Codeine","","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Valacyclovir","500 MG","","Select","Select",""],["","","Gabapentin","100 MG","","Select","Select",""],["","","Pregabalin","50 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Ketorolac Tromethamine","10 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Albuterol Sul","2.5 MG","","Select","Select",""],["","","Trelegy Ellipta 200-62.5-25","","","Select","Select",""],["","","Benzonatate","100 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 Mg","","","Select","Select",""],["","","Ofloxacin","3 MG","","Select","Select",""],["","","Lisdexamfetamine Dimesylate","60 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Alprazolam","0.5 MG","","Select","Select",""],["","","Hydrocodone\/Acetaminophen","","","Select","Select",""],["","","Celecoxib","50 MG","","Select","Select",""],["","","Oxycodone Hydrochloride","5 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","{2","480 ML","","Select","Select",""],["","","Albuterol Sulfate","","","Select","Select",""],["","","Homatropine Methylbromide","0.3 MG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Hydroxyzine Hydrochloride","25 MG","","Select","Select",""],["","","Aspirin Low Dose","","","Select","Select",""],["","","Diflorasone Diacetate","0.0005 MG","","Select","Select",""],["","","Cyanocobalamin","","","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":""}]}]}