{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John Bernard Prince","gend":0,"currentgend":"","add":"1195 Pea Ridge Rd","city":"Juliette","state":"GA","zip":31046,"dob":"1974-01-21","age":"","mstatus":"","insh":"0007890297002","cliId":"","pno":"4785502868","cno":4789551413,"email":"princej1969@yahoo.com","ename":"","eno":"","pphy":"Mark Hendricks","ppno":4787442445,"pcpadd":"458 HEMLOCK ST STE 200","pcpcity":"MACON","pcpstate":"GA","pcpzip":31201,"pcpcounty":"","pcpid":"","pcpname":"458 HEMLOCK ST STE 200","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"1195 Pea Ridge Rd","madd2":"","madd3":"","mcity":"Juliette","mstate":"GA","mzip":31046,"pcpfaxno":4787440906,"pcpnpi":1306827639,"currentgendcomment":"","pphycomment":"","uniqueid":426262,"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":["I10","G47.411","F41.1","M06.4","M79.10","H53.2","R53.1","R35.1","R20.0","R41.3","M79.662","F90.0","G89.4","Z79.899","Z51.81","F11.20","E34.9","I13.10","R10.11","R37","M62.81","M54.51","M54.2","F51.01","E29.1","N52.01","K21.9","G70.00","R53.82","R79.89","R40.0","Z68.30","G47.33","G70.01","R53.83","G89.29","F41.9","N52.9","J01.90","E78.2","E55.9","G43.001","M79.18","H53.8","R51.0","H93.19","R52","M12.59","G89.21","R26.9","R07.2","R06.02","R42","Z72.0","Z82.49","R00.2","M79.604","M79.605","Z68.32","M54.50","M47.812","M47.814","M47.816","R93.3","G62.89","T81.30X","R63.5","Z53.29","R19.7","G62.9","M12.9","G47.9","Z87.81","E66.09","Z68.33","Z71.3","Z87.898","F17.200","N18.4","I12.9","F32.A","K58.0","S31.501","R51.9","R05.9","B96.89","M60.9","D75.1","D51.0","Z12.5","Z00.00","M54.12","G56.03","M25.50","Z76.0","Z80.0","R10.84","Z86.010","M54.16","R20.2","R94.131","R10.13","Z09","R07.89","R06.00","F17.211","R91.8","R09.82","M25.551","R91.1","B00.1","R07.9","A77.0","H93.13","L50.9","Z86.19","H53.9","R10.0","R41.82","R94.31","G44.86","K61.0","M54.6","G47.00","Z68.34","K76.0","R19.4","K62.89","R05.3","E66.8","D72.821","I70.0","N18.2","Z01.818","G43.909","M48.061","E66.811","S32.402","M87.851","R41.0","Z68.36"],"date":["2026-01-13","2025-12-23","2026-01-13","2025-09-03","2025-09-03","2025-10-21","2025-11-21","2024-12-03","2025-07-24","2025-07-24","2025-04-09","2025-04-08","2025-12-23","2025-11-25","2025-04-08","2025-04-08","2025-04-08","2024-08-01","2024-03-01","2024-12-23","2024-10-24","2024-06-25","2024-06-25","2025-12-23","2025-12-23","2025-11-25","2025-12-23","2026-01-13","2025-12-23","2026-01-13","2026-01-13","2024-10-24","2026-03-02","2026-03-04","2025-09-12","2024-09-11","2025-01-23","2025-02-21","2024-12-23","2025-06-06","2024-12-23","2025-06-16","2026-01-13","2024-11-26","2025-01-02","2024-11-26","2025-05-29","2024-05-28","2024-05-28","2024-05-28","2025-06-06","2025-06-06","2025-06-06","2025-06-06","2025-06-06","2025-06-06","2025-06-06","2025-06-06","2025-06-06","2025-04-04","2025-04-04","2025-04-04","2025-04-04","2025-05-22","2024-08-20","2024-10-14","2024-08-01","2024-09-30","2025-06-19","2024-10-13","2024-05-13","2025-01-23","2024-05-13","2024-03-01","2025-04-03","2024-03-01","2024-03-01","2025-05-20","2024-10-13","2024-10-13","2024-10-13","2024-10-13","2024-10-13","2025-06-16","2025-05-22","2024-05-30","2024-05-30","2025-08-06","2024-08-01","2024-06-21","2024-06-21","2024-07-01","2024-07-01","2024-11-25","2025-02-21","2025-05-22","2025-09-08","2025-09-12","2024-07-08","2024-07-19","2024-07-08","2025-09-08","2024-03-15","2025-09-12","2025-08-06","2025-08-06","2025-08-06","2025-08-06","2024-08-23","2024-08-23","2024-09-26","2025-08-06","2024-06-21","2024-06-21","2024-08-13","2024-08-01","2024-08-01","2024-10-13","2024-10-13","2025-05-20","2024-06-18","2024-09-30","2024-07-19","2025-04-03","2025-02-03","2025-06-19","2025-09-12","2024-09-30","2025-08-06","2024-08-23","2024-10-07","2024-03-04","2024-04-09","2025-06-06","2025-06-17","2025-02-11","2025-04-03","2024-03-25","2024-03-25","2024-10-13","2024-08-23"],"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":[["","","Valacyclovir","1000 MG","","Select","Select",""],["","","Alprazolam","1 MG","","Select","Select",""],["","","24 Hr Venlafaxine","37.5 MG","","Select","Select",""],["","","Zolpidem Tartrate","5 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Amitriptyline Hydrochloride","10 MG","","Select","Select",""],["","","Vitamin B12","1 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Duloxetine","30 MG","","Select","Select",""],["","","Belsomra","20 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Metoprolol Tartrate","50 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Amphetamine Aspartate","5 MG","","Select","Select",""],["","","Pyridostigmine Bromide","60 MG","","Select","Select",""],["","","Emgality","","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Fluticasone Propionate","0.05 MG","","Select","Select",""],["","","Azelastine Hydrochloride","0.137 MG","","Select","Select",""],["","","Dicyclomine Hydrochloride","10 MG","","Select","Select",""],["","","Modafinil","100 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Dexlansoprazole","60 MG","","Select","Select",""],["","","24 Hr Isosorbide Mononitrate","30 MG","","Select","Select",""],["","","Buprenorphine","0.075 MG","","Select","Select",""],["","","Lisdexamfetamine Dimesylate","20 MG","","Select","Select",""],["","","Topiramate","25 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","10 MG","","Select","Select",""],["","","Testosterone Cypionate","","","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":""}]}]}