{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Terry Lee Richardson","gend":0,"currentgend":"","add":"243 Baggs Ave SE","city":"Pelham","state":"GA","zip":31779,"dob":"1964-03-23","age":"","mstatus":"","insh":"0007285098001","cliId":"","pno":2292014370,"cno":"","email":"","ename":"","eno":"","pphy":"Ivana Okor","ppno":7185796679,"pcpadd":"417 W 3RD AVE","pcpcity":"ALBANY","pcpstate":"GA","pcpzip":31701,"pcpcounty":"","pcpid":"","pcpname":"417 W 3RD AVE","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"243 Baggs Ave SE","madd2":"","madd3":"","mcity":"Pelham","mstate":"GA","mzip":31779,"pcpfaxno":"","pcpnpi":1396233243,"currentgendcomment":"","pphycomment":"","uniqueid":425633,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M75.122","M25.512","Z20.822","Z79.82","Z79.891","M19.012","M25.511","A41.9","I10","Z79.899","E11.21","R82.998","E11.9","E66.09","G89.18","Z23","S46.012","N39.0","R31.29","F11.20","G89.29","G89.28","R97.20","F11.10","M75.40","Z91.148","G56.81","G56.82","K59.03","R09.81","N10","I12.9","E78.49","N18.2","R35.89","J11.1","R05.9","Z68.35","D12.0","D12.3","D12.4","D12.2","K62.1","K57.30","L50.0","R68.83","N30.01","K21.9","Z98.890","D12.8","K63.5","Z12.11","Z12.12","H25.033","Z01.01","H52.223","H52.4","H11.31","N12","G89.4","F11.90","M75.110","Z13.6"],"date":["2025-12-30","2026-01-28","2025-05-23","2025-05-23","2025-08-15","2025-04-07","2026-02-23","2025-04-18","2025-08-01","2025-12-30","2025-12-23","2025-03-21","2024-12-20","2024-12-20","2025-12-30","2025-09-19","2025-10-20","2026-01-09","2026-01-09","2025-08-15","2025-08-15","2025-08-15","2026-01-09","2025-08-15","2025-08-15","2025-08-15","2025-08-15","2025-08-15","2025-08-15","2026-02-12","2025-05-23","2025-12-23","2025-12-23","2025-09-19","2025-05-30","2026-02-12","2026-02-12","2026-02-12","2025-06-23","2025-06-23","2025-06-23","2025-06-23","2025-06-19","2025-06-19","2025-08-15","2025-03-07","2025-03-07","2025-12-23","2024-07-29","2025-06-23","2025-06-23","2025-06-23","2025-06-23","2025-07-01","2025-07-01","2025-07-01","2025-07-01","2025-05-08","2025-05-23","2025-11-13","2025-11-13","2025-11-13","2025-12-19"],"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":[["","","Meloxicam","15 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Hydrochlorothiazide","25 MG","","Select","Select",""],["","","Gabapentin","600 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Aspirin Ec","81 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Chlorhexidine 0.12% Rinse","","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Polyethylene Glycol 3350","236000 MG","","Select","Select",""],["","","Buprenorphine-Nalox 2-0.5Mg Tb","","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Aspirin Adult Low Dose","","","Select","Select",""],["","","Tamsulosin Hydrochloride","0.4 MG","","Select","Select",""],["","","12 Hr Orphenadrine Citrate","100 MG","","Select","Select",""],["","","Diclofenac Sodium","75 MG","","Select","Select",""],["","","Hydroxyzine Hydrochloride","","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Pravastatin Sodium","40 MG","","Select","Select",""],["","","Buprenorphine Hydrochloride\/Naloxone Hydrochloride","","","Select","Select",""],["","","Acetaminophen\/Codeine","","","Select","Select",""],["","","Losartan Potassium","25 MG","","Select","Select",""],["","","Etodolac","400 MG","","Select","Select",""],["","","Aspirin","81 MG","","Select","Select",""],["","","Alprazolam","1 MG","","Select","Select",""],["","","Naproxen","500 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Oxycodone\/Acetaminophen","","","Select","Select",""],["","","Aspirin Low Dose","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Promethazine Dm","","","Select","Select",""],["","","Metformin Hydrochloride","500 MG","","Select","Select",""],["","","Farxiga","","","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":""}]}]}