{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lisa Southers-Stewart","gend":1,"currentgend":"","add":"5587 Odum Smallwood Rd","city":"Gainesville","state":"GA","zip":30506,"dob":"1963-06-22","age":"","mstatus":"","insh":"0006705410002","cliId":"","pno":6783166944,"cno":6783166944,"email":"lsouthers2010@yahoo.com","ename":"","eno":"","pphy":"Joshua Colliver","ppno":7705341856,"pcpadd":"743 SPRING ST NE","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":305013715,"pcpcounty":"","pcpid":"","pcpname":"743 SPRING ST NE","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"5587 Odum Smallwood Rd","madd2":"","madd3":"","mcity":"Gainesville","mstate":"GA","mzip":30506,"pcpfaxno":"","pcpnpi":1528332939,"currentgendcomment":"","pphycomment":"","uniqueid":368164,"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":["M86.171","I50.22","I11.0","N17.9","L03.115","E11.42","B95.1","B95.61","L02.611","B96.4","E11.621","E11.51","L97.512","E11.622","E11.628","E11.65","I25.10","Z95.5","G60.8","I25.5","Z95.810","J06.9","Z68.24","E11.9","Z79.02","Z79.82","Z82.49","D50.9","R06.02","J90","I50.21","L97.514","I73.9","L97.529","L97.519","Z89.411","E11.00","E78.2","Z98.61","Z68.23","R07.9","Z00.00","Z68.22","R79.1","N28.89","J18.9","K82.8","R18.8","Z48.813","J98.11","I34.0","E11.40","Z66","I31.39","J91.8","K76.9","N39.0","Z89.431","Z79.4","N28.1","Z79.899","Z88.5","Z45.02","S98.111","I36.1","M86.9","A49.1","E11.69","Z68.25","E11.59","L97.518","R60.0","I50.23","I47.29","Z68.27","I50.41","I25.83","H93.13","F32.A","M25.512","A49.01","A49.8","Z68.26","R06.89","R60.9","K59.00","S91.109","S91.301","R19.7","I15.2","R91.8","L97.516","D72.820","R74.01","R45.89","M79.604","R93.2","Z87.828","M79.89","I42.9","Z82.41","L08.9","S91.102"],"date":["2025-12-15","2026-03-06","2025-10-27","2025-10-27","2025-10-27","2025-11-24","2025-10-27","2025-10-27","2025-11-24","2025-10-27","2025-12-15","2025-10-27","2025-12-18","2025-10-27","2025-12-18","2025-10-27","2025-10-27","2025-10-27","2025-10-27","2026-03-18","2026-03-18","2024-12-23","2024-12-23","2026-01-08","2024-12-16","2024-12-16","2024-12-16","2024-09-10","2024-03-09","2024-05-09","2025-12-11","2025-12-15","2025-11-24","2024-06-14","2025-10-23","2024-04-30","2025-03-12","2024-05-09","2025-10-27","2024-10-29","2024-12-16","2024-08-20","2024-08-15","2024-03-07","2024-03-07","2024-03-10","2024-03-07","2024-03-07","2024-03-07","2024-03-07","2024-08-21","2025-12-11","2024-03-06","2024-07-25","2024-03-06","2024-03-19","2024-03-06","2024-03-06","2024-03-06","2024-03-19","2024-03-06","2024-03-06","2025-03-17","2026-01-08","2024-03-07","2025-12-18","2025-11-24","2025-10-27","2025-01-24","2026-03-06","2025-10-22","2025-10-23","2024-03-09","2026-03-18","2026-03-18","2024-05-03","2024-05-03","2025-03-06","2025-03-06","2025-03-06","2025-12-15","2025-12-15","2026-03-06","2024-02-27","2024-03-15","2024-02-27","2025-12-21","2025-12-21","2025-12-11","2026-03-06","2024-03-09","2024-03-08","2024-03-06","2024-03-19","2024-04-30","2025-10-25","2024-03-06","2026-01-08","2025-10-23","2024-03-07","2024-03-07","2025-12-18","2024-01-28"],"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","40 MG","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","Brilinta","90 MG","","Select","Select",""],["","","Farxiga","10 MG","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Losartan Potassium","50 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","50 MG","","Select","Select",""],["","","1 Ml Evolocumab","140 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","5 MG","","Select","Select",""],["","","Potassium Chloride","20 MEQ","","Select","Select",""],["","","Sertraline","50 MG","","Select","Select",""],["","","Duloxetine","30 MG","","Select","Select",""],["","","Benzonatate","100 MG","","Select","Select",""],["","","Fluticasone Propionate","0.05 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Torsemide","20 MG","","Select","Select",""],["","","Ticagrelor","","","Select","Select",""],["","","Linezolid","600 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","24 Hr Metformin Hydrochloride","500 MG","","Select","Select",""],["","","Repatha Sureclick","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Gentamicin 0.1% Ointment","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Aspirin","81 MG","","Select","Select",""],["","","Rosuvastatin Calcium","10 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 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":""}]}]}