{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Louanna Jean Chapel","gend":1,"currentgend":"","add":"6010 Goett Rd","city":"Dearing","state":"GA","zip":30808,"dob":"1970-01-16","age":"","mstatus":"","insh":"0007005536001","cliId":"","pno":7063615809,"cno":"","email":"louannachapel1@gmail.com","ename":"","eno":"","pphy":"Ian Herskowitz","ppno":7067745995,"pcpadd":"4720 WASHINGTON RD","pcpcity":"EVANS","pcpstate":"GA","pcpzip":30809,"pcpcounty":"","pcpid":"","pcpname":"4720 WASHINGTON RD","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"6010 Goett Rd","madd2":"","madd3":"","mcity":"Dearing","mstate":"GA","mzip":30808,"pcpfaxno":7067745996,"pcpnpi":1295880680,"currentgendcomment":"","pphycomment":"","uniqueid":400265,"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":["Z00.00","Z68.23","I10","M54.9","G89.29","M54.2","Z95.0","Z98.890","R42","R55","I95.9","J40","R30.0","K21.9","M48.02","A08.4","E86.0","G47.30","I25.2","F45.42","J43.9","M17.12","M41.9","M46.1","M75.41","N39.0","Z79.899","Z87.891","Z88.0","Z88.5","Z91.030","Z86.14","Z98.1","T81.49X","M47.812","I47.19","R31.9","Z78.0","M54.12","R79.89","I47.10","R00.1","I49.5","G95.9","Z86.16","Z47.89","Z55.6","M94.262","R07.81","Z68.25","M54.50","Z68.24","G89.4","Z79.891","M46.02","H60.392","Z71.3","Z71.82","G99.2","I25.10","F11.20","R35.0","D68.9","R00.0","T81.41X","Z71.89","Z96.7","I47.9","M46.04","M50.11","M47.22","M47.12","M47.813","M48.03","H53.9","M47.9","J31.0","K52.9","D72.829","J30.1","Z51.5","M75.42","J30.2","Z01.818","F17.200","T81.9XX","M25.512","R07.2","R00.2","T81.42X","R63.4","M47.892","M47.816","M41.26","F11.90","M50.123","J98.11","Z01.811","R07.1","Z12.12","Z12.11","S20.212","F17.210","Z45.010","Z45.018","G56.01"],"date":["2024-12-09","2026-02-26","2026-02-27","2026-02-26","2026-02-26","2026-01-28","2026-02-25","2024-12-09","2026-01-28","2026-01-28","2026-01-28","2026-02-25","2026-01-28","2025-03-06","2024-11-08","2023-11-18","2023-11-18","2023-11-18","2024-10-31","2023-11-18","2024-12-20","2024-09-09","2024-10-16","2023-11-18","2023-11-18","2023-11-18","2024-10-31","2024-12-20","2024-10-31","2023-11-18","2023-11-18","2024-10-31","2024-10-31","2024-12-14","2024-11-08","2026-02-25","2026-02-27","2026-02-27","2024-10-16","2025-09-09","2026-02-26","2026-02-12","2026-02-12","2024-10-16","2024-10-31","2024-12-20","2024-12-20","2024-09-09","2025-02-17","2025-02-13","2026-02-25","2025-11-25","2026-03-09","2026-01-22","2025-09-10","2025-11-25","2026-02-26","2026-02-26","2024-10-16","2024-10-16","2024-11-18","2024-10-09","2024-10-09","2026-02-25","2024-11-25","2024-11-25","2024-11-25","2024-10-31","2025-09-10","2024-07-16","2024-07-16","2024-09-05","2024-07-16","2024-07-16","2026-02-26","2024-11-01","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-03-09","2024-02-14","2025-06-03","2026-02-26","2024-05-07","2024-11-01","2024-04-04","2023-12-27","2025-03-21","2024-11-01","2025-08-15","2024-11-05","2025-06-25","2025-06-25","2024-11-18","2024-05-31","2024-11-01","2024-10-09","2024-10-09","2025-02-25","2025-02-25","2025-02-17","2024-03-28","2024-03-28","2024-03-28","2024-04-26"],"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":[["","","Ibuprofen","800 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","10 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Pregabalin","50 MG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Ofloxacin","","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Bisoprolol Fumarate","5 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Naloxone Hcl","4 MG","","Select","Select",""],["","","Carvedilol","12.5 MG","","Select","Select",""],["","","Onetouch Delica Plus","33 G","","Select","Select",""],["","","Oxycodone Hcl Ir","5 MG","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Flecainide Acetate","50 MG","","Select","Select",""],["","","Chlorhexidine Gluconate","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 5-325","","","Select","Select",""],["","","Polyethylene Glycol 3350","420000 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Onetouch Ultra Test Strip","","","Select","Select",""],["","","Levofloxacin","750 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","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":""}]}]}