{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Simone Beevers","gend":1,"currentgend":"","add":"3059 Clairmont Ave","city":"Macon","state":"GA","zip":"31204","dob":"1960-10-26","age":"","mstatus":"","insh":"0009047312002","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Sabry Gabriel","ppno":"4782101670","pcpadd":"101 GATEWAY DR","pcpcity":"MACON","pcpstate":"GA","pcpzip":"31210","pcpcounty":"","pcpid":"","pcpname":"101 GATEWAY DR","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3059 Clairmont Ave","madd2":"","madd3":"","mcity":"Macon","mstate":"GA","mzip":"31204","pcpfaxno":"4782105813","pcpnpi":"1730288424","currentgendcomment":"","pphycomment":"","uniqueid":"483147","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":["E78.2","G93.32","N95.1","Z00.00","Z41.9","Z01.812","K31.7","Z79.899","E78.5","D12.4","K64.8","Z86.010","R92.8","I87.2","M79.604","M79.605","I83.812","I83.811","R68.89","R10.20","R93.89","Z80.41","Z01.419","R10.13","N85.8","R79.89","Z12.31","Z11.3","N85.9","H90.3","R09.81","M17.11","M54.50","M54.59","Z01.810","I49.3","K29.50","R11.0","R14.0","R13.19","R10.11","Z12.11","R68.81","R63.4","Z91.89","Z12.12","H01.009","L82.1","D18.01","L81.4","L84","Z12.83","B07.8","Z13.6","Z09","K63.5","N95.2","R92.1","R92.322","Z71.82","Z68.20","Z71.3","Z13.89"],"date":["2026-03-05","2026-03-05","2026-03-05","2026-02-04","2026-03-03","2026-03-03","2026-05-08","2026-05-08","2026-05-08","2026-08-14","2026-08-14","2026-08-14","2026-04-13","2026-08-19","2026-08-19","2026-08-19","2026-08-19","2026-08-19","2026-08-19","2026-03-12","2026-03-12","2026-03-12","2026-07-30","2026-05-18","2026-03-12","2026-02-04","2026-02-04","2026-02-04","2026-03-12","2026-02-02","2026-02-02","2026-08-19","2026-08-19","2026-08-19","2026-03-06","2026-03-06","2026-04-28","2026-05-18","2026-05-18","2026-05-08","2026-05-18","2026-04-28","2026-05-08","2026-05-08","2026-04-28","2026-04-28","2026-06-25","2026-08-11","2026-08-11","2026-08-11","2026-08-11","2026-08-11","2026-08-11","2026-03-03","2026-08-14","2026-08-14","2026-03-12","2026-04-13","2026-04-13","2026-03-05","2026-03-05","2026-03-05","2026-03-05"],"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":[["","","SIMVASTATIN","10000 MG","","Select","Select",""],["","","OMEPRAZOLE DR","20000 MG","","Select","Select",""],["","","FLECAINIDE ACETATE","50000 MG","","Select","Select",""],["","","ERYTHROMYCIN","5000 MG\/GM","","Select","Select",""],["","","CELECOXIB","200000 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":""}]}]}