{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kaitlyn Seymour","gend":1,"currentgend":"","add":"676 Tom Teague Rd","city":"Cleveland","state":"GA","zip":30528,"dob":"1995-02-18","age":"","mstatus":"","insh":"0006722919002","cliId":"","pno":7066334910,"cno":7066334910,"email":"","ename":"","eno":"","pphy":"Morris Pulliam","ppno":7702199260,"pcpadd":"2578 HELEN HWY","pcpcity":"CLEVELAND","pcpstate":"GA","pcpzip":30528,"pcpcounty":"","pcpid":"","pcpname":"2578 HELEN HWY","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"676 Tom Teague Rd","madd2":"","madd3":"","mcity":"Cleveland","mstate":"GA","mzip":30528,"pcpfaxno":"","pcpnpi":1508985607,"currentgendcomment":"","pphycomment":"","uniqueid":214428,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","Z20.822","R05.1","H10.31","Z68.31","J01.90","K64.9","K62.89","Z68.30","R52","I10","E11.9","E50.8","E03.9","E55.9","E46","L25.9","F41.9","Z13.31","Z68.33","E66.9","L70.9","Z00.00","B00.1","L71.9","E66.811","K64.8","L29.9","S00.35X","L08.9","Z68.26"],"date":["2026-01-16","2025-12-28","2025-02-11","2025-05-09","2026-01-16","2026-01-16","2025-10-01","2025-10-01","2025-12-22","2025-12-28","2025-04-28","2025-04-28","2025-04-28","2025-04-28","2025-04-28","2025-04-28","2025-09-11","2025-08-08","2025-04-29","2024-09-03","2024-09-03","2024-09-03","2025-04-29","2025-04-29","2025-04-29","2025-08-08","2025-09-24","2025-09-11","2025-12-22","2025-12-22","2025-08-08"],"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":[["","","Fluoxetine","40 MG","","Select","Select",""],["","","Valacyclovir Hcl 1 Gram Tablet","","","Select","Select",""],["","","Valacyclovir Hydrochloride","","","Select","Select",""],["","","Acyclovir","0.05 MG","","Select","Select",""],["","","Metronidazole","","","Select","Select",""],["","","Polymyxin B 10000 Unt\/Ml \/ Trimethoprim","1 MG","","Select","Select",""],["","","Buspirone Hydrochloride","5 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Hydrocortisone","","","Select","Select",""],["","","Mupirocin","0.02 MG","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","Amoxicillin\/Clavulanate Potassium","","","Select","Select",""],["","","Triamcinolone Acetonide","1 MG","","Select","Select",""],["","","Hydroxyzine Pamoate","","","Select","Select",""],["","","Hydrocortisone Acetate","25 MG","","Select","Select",""],["","","Doxycycline Hyclate","","","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":""}]}]}