{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jerry Martin","gend":0,"currentgend":"","add":"2758 Wynelle Dr","city":"Gainesville","state":"GA","zip":30506,"dob":"1964-04-18","age":"","mstatus":"","insh":"0006426188001","cliId":"","pno":6789432902,"cno":6789432902,"email":"jerry@peachstatedentalstudio.com","ename":"","eno":"","pphy":"Saksham Sulove","ppno":7702190026,"pcpadd":"1439 JESSE JEWELL PKWY NE STE 202","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":30501,"pcpcounty":"","pcpid":"","pcpname":"1439 JESSE JEWELL PKWY NE STE 202","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"2758 Wynelle Dr","madd2":"","madd3":"","mcity":"Gainesville","mstate":"GA","mzip":30506,"pcpfaxno":"","pcpnpi":1871881508,"currentgendcomment":"","pphycomment":"","uniqueid":351009,"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":["D61.818","R65.10","E11.22","B96.1","E78.2","N18.30","I12.9","N39.0","N41.0","E11.42","Z79.4","Z68.27","I10","R63.8","Z68.31","R39.12","N32.89","F17.290","G47.33","E55.9","N40.1","R19.7","F17.220","N52.9","N18.2","Z68.32","H40.013","R09.89","N28.1","R00.0","R50.9","R25.2","K63.5","K62.1","D22.5","D22.71","L81.4","L82.1","L85.3","Z71.89","Z00.00","N40.0","K58.9","E11.9","R23.2","Z12.11","D12.0","D12.3","D12.2","D12.5","D12.8","D62","N13.8","Z01.818","D70.9","N17.9","Z68.26","R07.9","L98.8","E11.329","H25.13","H52.7","J20.9","R10.13","R78.81","G47.00","G89.29","M54.12","G62.9","M54.41","I11.9","R68.82","R53.83","S43.431","Z68.33","Z20.822","M79.10","L72.8","L53.8","R20.8","L29.8","R52","R05.1","J22","I95.2","Z87.438","R31.0","J06.9","Z11.4","B99.9","Z79.899","D84.81","R10.9","R20.2","N52.8"],"date":["2025-07-18","2025-07-18","2025-07-18","2025-07-18","2026-01-14","2025-07-18","2025-07-18","2025-10-07","2025-08-18","2026-01-15","2026-01-15","2025-07-09","2025-04-21","2023-05-03","2024-02-28","2025-07-11","2025-07-11","2025-07-11","2025-07-09","2026-01-15","2025-10-15","2025-06-07","2025-06-07","2026-01-15","2024-06-19","2024-05-29","2024-10-03","2025-07-15","2025-07-15","2025-07-15","2025-07-15","2025-04-02","2025-03-03","2025-03-03","2024-05-16","2024-05-16","2024-05-16","2024-05-16","2024-05-16","2024-05-16","2024-11-13","2025-07-14","2025-07-14","2025-07-18","2025-07-14","2025-03-03","2025-03-03","2025-03-03","2025-03-03","2025-03-03","2025-03-03","2025-07-28","2025-07-28","2025-07-09","2025-04-21","2025-04-21","2026-01-14","2025-06-07","2023-05-22","2024-04-02","2024-04-02","2024-04-02","2023-12-04","2025-06-07","2025-07-18","2025-10-07","2025-10-07","2025-10-07","2025-10-07","2025-10-07","2026-01-14","2026-01-14","2026-01-14","2023-11-20","2023-08-09","2025-06-05","2025-06-05","2023-05-22","2023-05-22","2023-05-22","2023-05-22","2025-02-16","2025-02-16","2025-02-16","2025-08-12","2025-07-18","2025-07-14","2023-10-04","2023-11-20","2025-08-18","2025-08-18","2025-08-18","2025-06-07","2023-05-09","2024-11-20"],"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":[["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Losartan Potassium","100 MG","","Select","Select",""],["","","Tresiba Flextouch","","","Select","Select",""],["","","Levofloxacin","750 MG","","Select","Select",""],["","","24 Hr Metformin Hydrochloride","500 MG","","Select","Select",""],["","","Tamsulosin Hydrochloride","0.4 MG","","Select","Select",""],["","","Simvastatin","40 MG","","Select","Select",""],["","","Pregabalin","25 MG","","Select","Select",""],["","","Trazodone Hydrochloride","50 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Amoxicillin","","","Select","Select",""],["","","Mounjaro","","","Select","Select",""],["","","Dexcom G7 Sensor","","","Select","Select",""],["","","Tolterodine Tartrate","2 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Temazepam","","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Azithromycin","250 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":""}]}]}