{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eddie Burgess","gend":0,"currentgend":"","add":"19 Richardson St","city":"Winder","state":"GA","zip":30680,"dob":"1973-01-30","age":"","mstatus":"","insh":"0009033632001","cliId":"","pno":7707282963,"cno":"","email":"sherylriley033@gmail.com","ename":"","eno":"","pphy":"Evan Hiner","ppno":7705342020,"pcpadd":"316 N BROAD ST","pcpcity":"WINDER","pcpstate":"GA","pcpzip":30680,"pcpcounty":"","pcpid":"","pcpname":"316 N BROAD ST","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"19 Richardson St","madd2":"","madd3":"","mcity":"Winder","mstate":"GA","mzip":30680,"pcpfaxno":"","pcpnpi":1821400441,"currentgendcomment":"","pphycomment":"","uniqueid":464705,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F17.210","Z59.71","R10.817","R10.31","I10","F10.10","E11.65","Z79.4","D72.829","Z91.199","E87.6","E86.0","E83.42","E10.10","G92.8","A04.0","K56.7","N17.9","F14.10","E83.52","E87.5","R19.7","Z91.148","R41.82","K52.9","R07.9","E78.5","Z68.29","K56.609","R10.9","R19.03","Z79.899","Z79.84","R42","N32.89","E78.2","F19.10","A63.0","R15.2","R10.84","K21.9","E66.3","Z68.25","E11.69","R19.5","Z68.23","R20.0","F10.90","E11.10","K92.0","F10.20","Z81.1","K51.90","S22.31X","V87.7XX","Z72.0","R55","R00.0","G93.40","R10.85","N39.0","Z68.27","R10.11","R93.49","G93.49","G45.9","K56.699","R20.2","K58.9","R10.10","K50.018","K52.0","R93.3","R73.9","K50.013"],"date":["2026-02-07","2025-03-01","2026-01-31","2026-02-07","2026-02-06","2025-12-03","2026-02-04","2026-01-02","2025-11-30","2025-11-24","2025-11-24","2025-11-24","2025-11-24","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-11-18","2025-11-11","2025-11-18","2025-11-18","2025-12-02","2025-11-18","2025-11-18","2026-02-24","2025-03-06","2025-09-08","2025-04-17","2026-01-02","2025-12-14","2025-12-14","2025-12-14","2025-12-14","2025-04-12","2025-11-30","2025-12-14","2025-12-14","2026-02-24","2025-12-03","2025-12-12","2026-02-04","2026-02-04","2026-02-04","2025-11-30","2025-12-03","2025-12-23","2025-05-31","2025-11-24","2025-11-11","2025-09-08","2025-09-08","2025-09-08","2025-12-02","2025-09-08","2025-09-08","2025-11-24","2025-11-04","2025-12-23","2025-11-11","2026-01-02","2026-01-31","2025-10-22","2025-11-30","2025-11-30","2025-11-07","2025-05-31","2026-02-24","2025-05-31","2025-12-12","2026-01-31","2025-12-02","2025-12-02","2025-12-02","2025-03-01","2025-11-21"],"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":[["","","Metronidazole","500 MG","","Select","Select",""],["","","Bd Pen Needle\/Mini\/Ultra-Fine\/31G X 5Mm","","","Select","Select",""],["","","Microencapsulated Potassium Chloride","20 MEQ","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Rosuvastatin Calcium","20 MG","","Select","Select",""],["","","24 Hr Glipizide","5 MG","","Select","Select",""],["","","24 Hr Metformin Hydrochloride","500 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Novolin 70\/30 Flexpen","","","Select","Select",""],["","","Onetouch Delica Plus Lancets Fine","30 G","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Metoclopramide Hydrochloride","","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Aspirin","81 MG","","Select","Select",""],["","","Methocarbamol","750 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":""}]}]}