{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christina L Payne","gend":1,"currentgend":"","add":"19 Glenda Dr SW","city":"Rome","state":"GA","zip":30165,"dob":"1969-10-22","age":"","mstatus":"","insh":"0007505444001","cliId":"","pno":7065121826,"cno":7065121826,"email":"christina.lyn.payne@gmail.com","ename":"","eno":"","pphy":"Randolph Sumner","ppno":7062909222,"pcpadd":"1825 MARTHA BERRY BLVD NW","pcpcity":"ROME","pcpstate":"GA","pcpzip":30165,"pcpcounty":"","pcpid":"","pcpname":"1825 MARTHA BERRY BLVD NW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"19 Glenda Dr SW","madd2":"","madd3":"","mcity":"Rome","mstate":"GA","mzip":30165,"pcpfaxno":7062900045,"pcpnpi":1700871555,"currentgendcomment":"","pphycomment":"","uniqueid":430335,"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":["F33.41","D47.3","F41.1","F90.0","D50.8","M25.512","M54.16","E53.8","I87.399","L20.9","E87.6","E11.22","N18.30","H35.322","M43.16","F41.9","E11.9","H35.323","Z96.1","I50.32","M51.36","I10","Z68.41","M41.56","D69.6","F32.A","K76.9","E66.01","Z98.84","K21.9","M47.26","M85.80","R73.09","J34.89","R11.2","N95.8","H35.321","N39.0","N18.6","Z23","Z98.890","D23.39","R00.0","R29.818","M81.0","M41.9","C44.311","Z98.1","M51.16","E66.9","M48.061","M43.26","Z78.0","M85.851","M85.852","M41.86","Z13.220","E78.2","N18.31","M99.53","M19.012","K91.2","Z86.39","R53.83","M54.50"],"date":["2026-03-10","2026-03-10","2026-03-10","2026-03-10","2026-03-10","2025-12-29","2025-09-10","2026-03-10","2025-06-09","2025-06-09","2025-06-09","2026-03-10","2026-03-10","2026-02-05","2024-07-19","2024-07-19","2025-12-29","2026-02-02","2026-02-02","2025-01-08","2024-06-24","2025-06-09","2024-07-19","2024-07-19","2024-07-19","2024-07-19","2024-07-19","2025-04-02","2024-07-19","2024-07-19","2024-07-19","2024-07-19","2024-10-11","2024-10-11","2025-01-08","2024-04-11","2025-07-24","2025-09-09","2025-09-09","2024-11-11","2025-10-27","2024-10-23","2024-07-11","2024-06-24","2024-06-05","2024-06-17","2024-10-23","2024-08-23","2024-07-19","2025-04-02","2024-06-03","2024-08-19","2024-06-17","2024-06-17","2024-06-17","2024-06-17","2025-12-29","2025-12-29","2025-12-29","2024-06-18","2025-09-11","2024-04-11","2024-04-11","2024-04-11","2024-06-03"],"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":[["","","Clonazepam","1 MG","","Select","Select",""],["","","Potassium Chloride","10 MEQ","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","24 Hr Desvenlafaxine Succinate","50 MG","","Select","Select",""],["","","Vitamin B12","1 MG","","Select","Select",""],["","","12 Hr Bupropion Hydrochloride","200 MG","","Select","Select",""],["","","Temazepam","30 MG","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Zonisamide","50 MG","","Select","Select",""],["","","Ziprasidone","80 MG","","Select","Select",""],["","","Amphetamine\/Dextroamphetamine","","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","Desvenlafaxine Succnt Er","50 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 5-325 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":""}]}]}