{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raynell Ettel","gend":1,"currentgend":"","add":"3209 Somerset Dr","city":"Macon","state":"GA","zip":"31206","dob":"1966-01-15","age":"","mstatus":"","insh":"0009051050001","cliId":"","pno":"4789780838","cno":"4789780838","email":"ettelraynell@yahoo.com","ename":"","eno":"","pphy":"Kasey Fish","ppno":"4788257000","pcpadd":"400 POPLAR ST","pcpcity":"MACON","pcpstate":"GA","pcpzip":"31201","pcpcounty":"","pcpid":"","pcpname":"400 POPLAR ST","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3209 Somerset Dr","madd2":"","madd3":"","mcity":"Macon","mstate":"GA","mzip":"31206","pcpfaxno":"","pcpnpi":"1558932004","currentgendcomment":"","pphycomment":"","uniqueid":"488358","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","1","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S93.421","S93.411","S93.401","I10","N39.3","N95.1","J44.9","Z12.4","Z23","Z68.33","R00.1","R07.9","Z87.891","E78.5","J44.1","R19.5","Z13.1","Z13.29","N64.4","M25.551","M25.552","E78.49","Z91.199","Z76.89","Z11.4","Z11.59","E66.811","Z12.11","Z12.31","Z68.34","E66.09","M79.89","H10.32","M79.604","M25.571","R94.31","C50.112","Z79.810","Z76.0","Z08","Z85.3","Z92.3","Z17.32","Z79.818","Z12.39","R92.333","S93.431"],"date":["2026-03-18","2026-03-18","2026-03-10","2026-08-04","2026-08-03","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2026-08-03","2026-03-09","2026-03-09","2026-03-09","2026-08-04","2026-08-03","2026-08-03","2026-08-04","2026-08-04","2026-08-03","2026-08-03","2026-08-03","2026-01-09","2026-01-05","2026-01-05","2026-01-09","2026-01-09","2026-03-03","2026-07-25","2026-03-03","2026-03-03","2026-05-01","2026-03-10","2026-02-20","2026-03-18","2026-03-18","2026-03-09","2026-04-07","2026-04-07","2026-01-13","2026-06-30","2026-06-30","2026-06-30","2026-06-30","2026-06-30","2026-06-22","2026-06-22","2026-03-18"],"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":[["","","LOSARTAN POTASSIUM","100000 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50000 MCG\/ACT","","Select","Select",""],["","","ALBUTEROL SULFATE","500 %","","Select","Select",""],["","","TAMOXIFEN CITRATE","20000 MG","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","5000 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","108000 MCG\/ACT","","Select","Select",""],["","","NEOMYCIN\/POLYMYXIN\/DEXAMETHASONE","0","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","10000 MG","","Select","Select",""],["","","IBUPROFEN","800000 MG","","Select","Select",""],["","","PREDNISONE","10000 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","2500 MG","","Select","Select",""],["","","AZITHROMYCIN","250000 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":""}]}]}