{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sheila A Bennett","gend":1,"currentgend":"","add":"225 Brady Ct","city":"Mount Airy","state":"GA","zip":30563,"dob":"1965-11-22","age":"","mstatus":"","insh":"0007226786001","cliId":"","pno":7069681564,"cno":7069681564,"email":"sheilabennett30535@yahoo.com","ename":"","eno":"","pphy":"Jonathan Cook","ppno":7063537747,"pcpadd":"700 Sunset Dr Ste 200A","pcpcity":"ATHENS","pcpstate":"GA","pcpzip":30605,"pcpcounty":"","pcpid":"","pcpname":"700 Sunset Dr Ste 200A","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"225 Brady Ct","madd2":"","madd3":"","mcity":"Mount Airy","mstate":"GA","mzip":30563,"pcpfaxno":7063537756,"pcpnpi":1467443713,"currentgendcomment":"","pphycomment":"","uniqueid":400248,"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":["J02.9","J32.9","B96.89","H60.332","M19.012","R29.898","N39.0","Z23","H74.8X9","S93.491","J06.9","S32.001","K21.9","J01.01","D62","S32.019","M48.061","E78.5","Z79.891","Z79.899","Z88.3","Z88.5","Z88.0","Z88.2","Z88.8","Z91.048","Z87.442","Z90.711","Z88.1","R07.0","H61.22","J32.0","J34.3","J34.2","J30.9","J31.0","R09.81","M25.511","M25.521","M54.50","S93.502","M54.16","J01.90","S09.93X","R05.3","J45.909","R42","S40.262","W57.XXX","S93.401","Z00.00","Z12.39","N30.00","R39.9","R30.0","R05.9","M25.512","M25.561","M25.532","Z12.31","Z12.11","M51.27","M47.817","M43.16","M47.816","J01.10","S49.91X","S46.911","G89.29","M62.81","R26.89","M77.8","L30.9","H93.292","R51.9","M47.26","S39.92X","S29.9XX","V89.9XX","Y92.488","M25.571","R22.41","Z68.26","R50.9","S32.029","J90","Z98.890","J81.1","M47.814","Z98.1","N32.81","R74.01","J10.1","J01.00","V87.7XX","R05.1","H69.92","R07.9","H60.502","M77.31","M51.37","S99.911","H60.8X2","S32.020","R09.02","R03.0","S22.20X","S22.22X","R07.89","R19.7","M79.18","W10.8XX","M51.36","I10","H60.63","H69.83","M54.41","J45.30","J32.2","S32.021","S93.512"],"date":["2025-11-21","2026-03-05","2026-03-05","2025-08-25","2025-03-07","2024-12-29","2024-12-11","2025-09-30","2024-11-04","2024-10-07","2025-11-21","2024-03-12","2026-01-05","2026-02-05","2024-03-06","2024-03-09","2024-03-06","2026-01-05","2026-01-05","2025-06-19","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-09-17","2026-03-05","2025-11-19","2025-01-15","2025-01-15","2025-11-19","2025-01-15","2025-01-15","2024-06-07","2025-10-20","2024-03-14","2025-01-08","2024-03-21","2023-12-21","2026-02-11","2025-12-01","2026-01-05","2024-06-27","2025-04-29","2025-04-29","2026-01-19","2026-01-05","2023-12-13","2025-07-10","2025-12-10","2025-01-02","2024-02-13","2025-12-15","2025-02-04","2024-08-14","2026-01-05","2026-01-05","2024-03-14","2024-03-21","2024-03-21","2024-04-18","2025-04-16","2024-06-07","2026-02-25","2024-03-12","2024-02-28","2024-02-28","2024-02-28","2026-02-09","2025-08-29","2024-01-17","2024-03-14","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-10-07","2024-10-07","2025-02-04","2025-02-17","2024-03-09","2024-03-09","2024-04-18","2024-03-09","2024-03-09","2024-04-18","2025-06-26","2024-12-27","2025-02-17","2025-04-03","2024-03-12","2025-10-13","2024-05-23","2024-03-06","2025-08-23","2024-09-07","2024-03-21","2024-09-07","2025-07-02","2024-03-07","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2026-02-03","2024-09-16","2024-09-16","2024-04-18","2024-07-05","2024-07-05","2024-07-05","2024-03-12","2025-11-19","2025-11-19","2024-03-07","2024-12-29"],"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":[["","","Montelukast","10 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","Myrbetriq Er","25 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","10 MG","","Select","Select",""],["","","Benzonatate","200 MG","","Select","Select",""],["","","Sucralfate","1000 MG","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Prednisone","5 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Azelastine Hydrochloride","0.137 MG","","Select","Select",""],["","","Hydrocortisone","10 MG","","Select","Select",""],["","","Bromphen-Pse-Dm 2-30-10 Mg\/5Ml","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","Fluticasone-Salmeterol 100-50","","","Select","Select",""],["","","24 Hr Oxybutynin Chloride","10 MG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Lorazepam","1 MG","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","Mupirocin","20 MG","","Select","Select",""],["","","Azithromycin","","","Select","Select",""],["","","Doxycycline Hyclate","","","Select","Select",""],["","","Ventolin Hfa","90 MCG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Ibuprofen","600 MG","","Select","Select",""],["","","Famotidine","","","Select","Select",""],["","","Promethazine\/Dextromethorphan","","","Select","Select",""],["","","Brompheniramine Maleate","0.4 MG","","Select","Select",""],["","","Nitrofurantoin Monohydrate","","","Select","Select",""],["","","Oxycodone Hcl Ir","5 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Levofloxacin","500 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Pantoprazole Sod Dr","40 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Fluticasone Propionate\/Salmeterol","","","Select","Select",""],["","","Triamcinolone Acetonide","0.001 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Meloxicam","7.5 MG","","Select","Select",""],["","","Betamethasone","0.5 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":""}]}]}