{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eula Myster","gend":1,"currentgend":"","add":"304 White St","city":"Tallapoosa","state":"GA","zip":30176,"dob":"1966-01-14","age":"","mstatus":"","insh":"0009033008001","cliId":"","pno":4044912477,"cno":"","email":"eulamyster@yahoo.com","ename":"","eno":"","pphy":"Muhammad Uneib","ppno":7078123000,"pcpadd":"601 DALLAS HWY","pcpcity":"VILLA RICA","pcpstate":"GA","pcpzip":30180,"pcpcounty":"","pcpid":"","pcpname":"601 DALLAS HWY","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"304 White St","madd2":"","madd3":"","mcity":"Tallapoosa","mstate":"GA","mzip":30176,"pcpfaxno":"","pcpnpi":1497286900,"currentgendcomment":"","pphycomment":"","uniqueid":463943,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.8","I10","F17.210","F33.1","C34.82","Z68.20","E55.9","K21.9","C79.31","C34.90","Z87.891","Z51.5","F17.219","Z79.899","Z51.12","C34.02","R90.89","R92.8","Z72.0","J96.01","C78.7","E44.0","I50.22","I13.0","Z68.1","N30.00","N17.9","I24.89","E78.2","N18.32","T45.1X5","D64.81","Z79.82","Z79.84","Z92.3","J39.8","Z13.89","R05.1","Z68.22","H61.23","G93.6","G93.5","D62","I11.0","F32.A","E87.1","I50.9","Z79.01","Z86.711","Z92.21","F41.9","Z59.86","Z88.0","Z91.81","Z71.6","K59.00","E86.9","Z11.52","I50.20","I42.8","J18.1","I26.99","I35.1","I67.89","R60.1","Z68.24","R93.1","F17.200","Z91.89","R26.89","F43.23","F06.4","Z68.23","F41.3","J98.4","C80.1","Z98.890","G93.9","R91.8","G93.89","E27.8","C34.80","D64.9","R22.43","I50.1","K57.30","F41.1","Z13.9","T66.XXX","G89.3","C34.92","I34.0","Z71.9","F33.0","J30.2","C34.12"],"date":["2025-12-16","2025-12-11","2025-10-31","2025-04-25","2026-02-21","2025-04-25","2025-04-25","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2025-09-30","2025-12-16","2026-02-21","2026-02-09","2025-04-30","2025-04-30","2025-04-30","2025-08-27","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2026-02-21","2025-12-31","2025-12-31","2025-12-31","2025-12-31","2025-12-31","2025-11-12","2025-07-23","2025-07-23","2026-02-21","2025-07-24","2025-07-25","2025-07-23","2026-02-21","2026-02-21","2025-07-23","2025-07-23","2025-07-23","2025-07-23","2025-11-12","2025-07-23","2026-02-21","2026-02-21","2026-02-21","2026-02-04","2025-12-03","2026-02-21","2025-12-11","2026-02-04","2025-08-27","2025-12-03","2025-12-03","2026-02-25","2025-05-23","2025-11-12","2025-11-12","2025-10-21","2025-12-02","2025-12-11","2025-11-14","2025-08-18","2025-07-23","2025-07-25","2025-07-24","2025-11-11","2026-01-12","2025-06-09","2026-02-24","2026-02-24","2026-02-09","2026-02-25","2025-11-10","2025-06-25","2025-11-12","2025-11-12","2025-11-12","2025-09-09","2025-07-18","2025-07-24","2025-10-31","2025-10-31","2025-07-14"],"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":[["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Hydroxyzine Pamoate","","","Select","Select",""],["","","Sertraline","50 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Jardiance","","","Select","Select",""],["","","Folic Acid","1 MG","","Select","Select",""],["","","Nicotine Transdermal System","","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Prochlorperazine","10 MG","","Select","Select",""],["","","Buspirone Hydrochloride","5 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Oxycodone Hydrochloride","5 MG","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","Dexamethasone","4 MG","","Select","Select",""],["","","Mirtazapine","15 MG","","Select","Select",""],["","","Lisinopril","2.5 MG","","Select","Select",""],["","","Metoprolol Tartrate","","","Select","Select",""],["","","Nystatin 100000 Unt\/Ml Oral Suspension","","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Duloxetine","20 MG","","Select","Select",""],["","","Quetiapine","25 MG","","Select","Select",""],["","","Furosemide","40 MG","","Select","Select",""],["","","Megestrol Acetate","","","Select","Select",""],["","","Valsartan","40 MG","","Select","Select",""],["","","12 Hr Bupropion Hydrochloride","100 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Lidocaine Hydrochloride","20 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Prochlorperazine Maleate","","","Select","Select",""],["","","Levofloxacin","750 MG","","Select","Select",""],["","","Lidocaine","25 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":""}]}]}