{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tytiarra Brown-Lee","gend":1,"currentgend":"","add":"727 2nd Ave SE Apt D","city":"Moultrie","state":"GA","zip":"31768","dob":"1996-04-18","age":"","mstatus":"","insh":"0009047876001","cliId":"","pno":"2294564376","cno":"","email":"","ename":"","eno":"","pphy":"James Lamon","ppno":"2299855200","pcpadd":"3131 S MAIN ST","pcpcity":"MOULTRIE","pcpstate":"GA","pcpzip":"31768","pcpcounty":"","pcpid":"","pcpname":"3131 S MAIN ST","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"Apt D","add3":"","madd1":"727 2nd Ave SE Apt D","madd2":"Apt D","madd3":"","mcity":"Moultrie","mstate":"GA","mzip":"31768","pcpfaxno":"2299851302","pcpnpi":"1013019033","currentgendcomment":"","pphycomment":"","uniqueid":"483932","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":["J06.9","R09.81","J02.9","Z13.31","Z13.9","Z30.09","Z71.3","Z71.82","R10.13","Z79.899","R11.2","R10.84","R00.0","R30.0","R06.02","R07.9","I10","E11.22","E78.2","N18.2","Z79.4","R01.1","E66.01","R20.2","E78.5","N39.0","K31.84","Z00.01","Z68.41","E10.43","R94.31","I12.9","L97.519","M79.89","E11.9","F41.9","Z78.9","R10.9","N83.202","M79.671"],"date":["2026-05-25","2026-05-25","2026-05-25","2026-05-25","2026-05-25","2026-05-25","2026-05-25","2026-05-25","2026-02-15","2026-02-15","2026-02-14","2026-02-14","2026-07-31","2026-02-14","2026-02-14","2026-02-14","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-07-11","2026-05-11","2026-05-11","2026-05-11","2026-07-31","2026-02-15","2026-02-15","2026-02-05","2026-02-05","2026-02-15","2026-02-15","2026-05-11","2026-07-11","2026-07-11","2026-07-11","2026-02-05","2026-02-05","2026-02-14","2026-02-14","2026-07-11"],"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":[["","","RIZATRIPTAN BENZOATE","10000 MG","","Select","Select",""],["","","ESCITALOPRAM OXALATE","10000 MG","","Select","Select",""],["","","VITAMIN D","1250 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100000 MG","","Select","Select",""],["","","INSULIN GLARGINE-YFGN","100000 UNIT\/ML","","Select","Select",""],["","","METOPROLOL SUCCINATE ER","200000 MG","","Select","Select",""],["","","OZEMPIC","8000 MG\/3ML","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","500000 MG","","Select","Select",""],["","","ACETAMINOPHEN\/CODEINE PHOSPHATE","0","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500000 MG","","Select","Select",""],["","","FARXIGA","10000 MG","","Select","Select",""],["","","AMOXICILLIN","500000 MG","","Select","Select",""],["","","DAPAGLIFLOZIN","10000 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":""}]}]}