{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susanna Claudia Schaefer","gend":1,"currentgend":"","add":"247 Sunset Ter","city":"Athens","state":"GA","zip":"30606","dob":"1967-09-30","age":"","mstatus":"","insh":"0009045314001","cliId":"","pno":"7064619927","cno":"7064619927","email":"susanna706@msn.com","ename":"","eno":"","pphy":"Walter Agyeman","ppno":"7064757055","pcpadd":"1199 PRINCE AVE","pcpcity":"ATHENS","pcpstate":"GA","pcpzip":"30606","pcpcounty":"","pcpid":"","pcpname":"1199 PRINCE AVE","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"247 Sunset Ter","madd2":"","madd3":"","mcity":"Athens","mstate":"GA","mzip":"30606","pcpfaxno":"","pcpnpi":"1295311082","currentgendcomment":"","pphycomment":"","uniqueid":"479310","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":["M72.6","N76.82","M25.552","I10","E11.9","E83.52","E55.9","E78.5","F41.9","N17.9","R53.81","Z43.3","E11.10","R65.21","N17.0","L89.150","Z66","M00.9","N76.4","B96.20","E11.22","E66.813","E89.0","I12.9","N18.9","Z68.41","Z79.4","Z93.3","J98.2","F90.9","I25.10","F43.22","Z80.7","E11.65","E08.10","E66.01","Z68.43","Z90.79","Z55.6","Z94.5","E43","J96.01","E87.1","Q43.8","D25.9","D64.9","E83.39","E83.51","G89.11","I89.0","Z87.11","Z79.84","Z87.39","E11.52","I95.1","Z51.5","L08.9","F32.A","T79.7XX","K44.9","E87.6","D25.1","M47.816","Z63.4","Z63.8","N17.8","E87.29","I95.89","E87.21","E08.65","Z88.1","A41.9","M79.89","E87.70","E11.628","I12.0","N18.6","R65.20","D62","L03.314","L03.315","Z45.2","R42","Z95.9","L90.5","Z00.00","K76.0","M62.81","Z96.0","Z87.42","Z86.39","E13.10","R52","Z71.89","I51.7","Z46.82","R03.0","R41.82","E87.20","R79.89","E66.9","R09.89","E87.79","N18.30","I21.4","N13.39","J96.00","Z99.2","Z03.89"],"date":["2026-05-15","2026-07-23","2026-06-13","2026-07-31","2026-07-16","2026-06-25","2026-06-25","2026-07-31","2026-06-25","2026-06-25","2026-06-25","2026-06-25","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-08-07","2026-05-15","2026-05-15","2026-08-05","2026-08-05","2026-07-16","2026-08-05","2026-07-23","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-07-31","2026-03-25","2026-07-31","2026-04-08","2026-07-31","2026-07-31","2026-07-31","2026-04-08","2026-04-08","2026-04-08","2026-04-08","2026-04-08","2026-07-29","2026-04-08","2026-04-08","2026-04-08","2026-04-08","2026-04-08","2026-04-08","2026-04-08","2026-05-06","2026-05-01","2026-03-25","2026-03-18","2026-03-18","2026-03-18","2026-03-18","2026-07-01","2026-03-18","2026-03-18","2026-03-18","2026-03-18","2026-07-01","2026-04-01","2026-07-01","2026-07-01","2026-07-22","2026-07-22","2026-04-27","2026-03-25","2026-04-09","2026-04-23","2026-04-23","2026-04-23","2026-04-02","2026-04-02","2026-04-02","2026-04-02","2026-03-31","2026-07-22","2026-04-24","2026-07-27","2026-07-16","2026-03-18","2026-07-06","2026-04-29","2026-07-16","2026-07-16","2026-03-19","2026-03-25","2026-03-25","2026-04-23","2026-04-02","2026-08-07","2026-03-18","2026-04-23","2026-03-19","2026-03-19","2026-04-07","2026-04-23","2026-07-29","2026-03-19","2026-04-02","2026-03-30","2026-04-24","2026-04-21"],"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":[["","","ONETOUCH DELICA PLUS LANCETS EXTRA FINE","0","","Select","Select",""],["","","HUMALOG KWIKPEN","100000 UNIT\/ML","","Select","Select",""],["","","DEXCOM G","0","","Select","Select",""],["","","TRESIBA FLEXTOUCH","100000 UNIT\/ML","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40000 MG","","Select","Select",""],["","","DROPLET PEN NEEDLES","0","","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":""}]}]}