{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan Bailey","gend":1,"currentgend":"","add":"3838 The Prado","city":"Macon","state":"GA","zip":31204,"dob":"1965-04-16","age":"","mstatus":"","insh":"0009026066002","cliId":"","pno":4787332535,"cno":"","email":"cbailey0921@gmail.com","ename":"","eno":"","pphy":"David Markham","ppno":7707160051,"pcpadd":"1968 PEACHTREE RD NW","pcpcity":"ATLANTA","pcpstate":"GA","pcpzip":30309,"pcpcounty":"","pcpid":"","pcpname":"1968 PEACHTREE RD NW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3838 The Prado","madd2":"","madd3":"","mcity":"Macon","mstate":"GA","mzip":31204,"pcpfaxno":"","pcpnpi":1871608489,"currentgendcomment":"","pphycomment":"","uniqueid":455399,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.82","Z79.899","Z79.4","Z79.624","Z79.52","Z79.621","M54.50","M99.01","M99.03","M99.02","M99.05","I47.10","I21.3","I42.8","I50.9","I25.10","R33.9","R63.8","Z01.818","D84.821","J18.9","E87.1","E11.9","F32.A","F41.9","G47.00","Z90.49","I50.23","Z94.1","D64.9","Z51.81","N18.9","Z23","T38.0X5","I20.89","R06.02","R00.2","I95.9","Z82.49","E78.2","R57.0","I50.20","I49.1","I49.3","F43.23","F43.29","H93.13","H90.3","H92.01","M26.69","Z48.21","E11.65","Z12.11","N87.0","N72","I51.9","Z51.89","Z13.6","J01.00","H65.93","I50.84","I27.20","I48.92","E78.5","F41.8","I25.5","I50.42","Z98.890","I07.1","D72.829","J18.1","Z48.01","F33.0","F41.1","Z79.2","J93.9","J81.1","T81.41X","D84.9","I25.110","K21.9","J95.1","G89.18","D62","J90","R91.8","K56.7","I50.21","R94.39","I20.0","R06.01","Z03.89","K46.9","R10.13","Z46.82","Z01.810","Z30.432","Z09","I50.22","I11.0","Z88.5","Z88.8","Z80.0","R73.9","R52","R00.0","Z12.31","I45.9","F33.1","F43.21","E55.9","M54.2","M62.830","Z01.419","R92.8","N28.89","R29.818","R11.2","R07.9","Z95.811","R16.0","K64.0","R20.0","R20.2","R47.9","R06.00","I25.83","R94.31","I49.9","R53.83","Z78.0","I51.7","I42.4","I70.8","J98.11","T86.21","E66.811","Z46.59","N30.01","T83.32X","R07.0","H92.09","I42.9","I36.1","K90.41","R14.0","Z00.00","K63.89","I34.0","I51.89","R51.9","R42","R03.0","R18.8"],"date":["2025-11-10","2026-02-12","2026-02-12","2025-11-10","2025-11-10","2025-11-10","2025-07-11","2025-07-11","2025-07-11","2025-07-11","2025-07-11","2025-09-16","2025-08-10","2025-09-12","2025-09-28","2025-08-10","2025-07-21","2025-07-21","2025-08-28","2025-10-15","2025-10-15","2025-10-15","2026-02-12","2025-10-29","2025-10-29","2025-10-29","2025-10-15","2025-11-10","2026-02-12","2025-09-28","2025-10-29","2025-09-28","2026-02-12","2026-02-12","2025-07-14","2025-08-26","2025-08-09","2025-07-26","2025-07-25","2025-08-04","2025-09-14","2025-10-14","2025-07-19","2025-07-25","2025-09-10","2025-09-10","2025-06-12","2025-12-31","2025-06-12","2025-06-12","2025-09-30","2025-11-11","2025-08-29","2025-10-16","2025-10-16","2025-10-30","2026-02-26","2025-09-15","2025-06-12","2025-06-12","2025-08-22","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2025-08-10","2025-08-10","2025-09-16","2025-12-17","2025-10-09","2025-10-06","2025-11-10","2025-11-10","2025-11-10","2025-11-10","2025-09-16","2025-09-22","2025-10-09","2025-10-29","2025-07-25","2025-08-09","2025-10-07","2025-10-07","2025-10-07","2025-09-28","2025-09-25","2025-09-21","2025-08-04","2025-07-25","2025-07-25","2025-07-25","2025-08-09","2025-08-05","2025-07-17","2025-09-13","2025-08-22","2025-02-05","2025-10-14","2025-09-16","2025-08-09","2025-08-09","2025-08-09","2025-08-09","2026-02-12","2025-08-09","2025-08-22","2025-01-08","2025-09-26","2025-08-14","2025-08-14","2025-08-14","2025-07-01","2025-01-16","2026-02-20","2026-02-20","2025-09-30","2025-08-10","2025-09-18","2025-07-26","2025-09-15","2025-08-12","2025-08-12","2025-08-09","2025-08-09","2025-08-09","2025-12-11","2025-08-04","2025-07-26","2025-02-19","2025-07-22","2025-02-19","2025-09-18","2025-09-18","2025-09-18","2025-09-28","2025-10-01","2026-01-29","2025-09-14","2025-03-07","2025-01-08","2025-09-14","2025-09-14","2025-09-16","2025-10-07","2025-10-29","2025-09-14","2025-08-22","2025-08-29","2025-07-14","2025-10-08","2025-08-10","2025-08-10","2025-08-10","2025-07-22"],"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":[["","","Eszopiclone","3 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Hydroxyzine Pamoate","","","Select","Select",""],["","","Buspirone Hydrochloride","10 MG","","Select","Select",""],["","","Trazodone Hydrochloride","50 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","Carvedilol","3.125 MG","","Select","Select",""],["","","Midodrine Hydrochloride","2.5 MG","","Select","Select",""],["","","Digoxin","0.125 MG","","Select","Select",""],["","","0.2 Ml Glucagon","5 MG","","Select","Select",""],["","","Onetouch Delica Plus Lancets Extra Fine","33 G","","Select","Select",""],["","","Humalog Kwikpen","","","Select","Select",""],["","","Prednisone","5 MG","","Select","Select",""],["","","24 Hr Desvenlafaxine Succinate","100 MG","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Tacrolimus","","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","5 MG","","Select","Select",""],["","","Freestyle Lancets","","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Embecta Pen Needle\/Nano 2Nd Gen\/32G X 4Mm","","","Select","Select",""],["","","Torsemide","20 MG","","Select","Select",""],["","","Mycophenolic Acid","360 MG","","Select","Select",""],["","","Aspirin","81 MG","","Select","Select",""],["","","3 Ml Insulin Glargine-Yfgn 100 Unt\/Ml Pen Injector","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Pravastatin Sodium","10 MG","","Select","Select",""],["","","Sulfamethoxazole","400 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Farxiga","","","Select","Select",""],["","","Lisinopril","5 MG","","Select","Select",""],["","","Embecta Pen Needle\/Nano 2Nd Gen\/32G X 5\/32\"","","","Select","Select",""],["","","Valacyclovir","500 MG","","Select","Select",""],["","","Voriconazole","200 MG","","Select","Select",""],["","","Lokelma","","","Select","Select",""],["","","Theophylline","300 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Freestyle Lite Test Strips","","","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":""}]}]}