{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Betty Mizell","gend":1,"currentgend":"","add":"642 Minchew Rd","city":"Axson","state":"GA","zip":"31624","dob":"1962-01-12","age":"","mstatus":"","insh":"0009054530001","cliId":"","pno":"9124225739","cno":"9124225739","email":"","ename":"","eno":"","pphy":"Shaista Hussain","ppno":"9123837826","pcpadd":"1101 OCILLA RD","pcpcity":"DOUGLAS","pcpstate":"GA","pcpzip":"31533","pcpcounty":"","pcpid":"","pcpname":"1101 OCILLA RD","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"642 Minchew Rd","madd2":"","madd3":"","mcity":"Axson","mstate":"GA","mzip":"31624","pcpfaxno":"9123837299","pcpnpi":"1952663866","currentgendcomment":"","pphycomment":"","uniqueid":"494143","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":["C02.1","N81.10","R06.02","N89.8","N94.10","C06.89","Z93.1","R79.0","E63.8","I10","I48.91","Z79.01","Z79.899","Z87.442","Z88.2","Z90.710","Z98.890","Z51.11","Z51.12","C76.0","R13.10","Z93.0","M10.9","E66.9","Z68.39","D64.81","D64.9","C78.00","R91.8","R13.11","G89.29","K94.23","R60.0","I48.0","R01.1","I82.402","C80.0","I49.8","R42","E83.52","Z85.89","I24.89","L02.11","K59.00","Z85.810","Z95.828","Z86.718","Z98.51","N81.89","Z43.1","C02.9","N20.0","I49.9","M62.81","C34.90","I12.9","N18.9","N39.0","R78.89","R10.9","C77.0","Z46.59","I51.7","I36.1","I65.23","I27.20","R06.83","I34.0","I95.9","C79.89","R11.0","C02.8","R59.0","C78.01","C78.02","Z46.82","N39.41","N32.81","N99.3","R87.5","R22.1","Z85.818"],"date":["2026-08-24","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-05-01","2026-07-13","2026-06-22","2026-06-08","2026-06-08","2026-06-08","2026-02-20","2026-01-12","2026-01-12","2026-08-24","2026-08-24","2026-04-23","2026-03-10","2026-02-10","2026-04-03","2026-05-25","2026-05-01","2026-04-28","2026-06-09","2026-04-28","2026-04-28","2026-04-28","2026-06-09","2026-08-13","2026-07-21","2026-04-23","2026-04-23","2026-05-11","2026-04-23","2026-04-22","2026-04-22","2026-04-22","2026-05-15","2026-02-19","2026-04-09","2026-02-19","2026-06-09","2026-04-24","2026-07-21","2026-01-15","2026-01-15","2026-04-27","2026-04-27","2026-04-22","2026-04-09","2026-05-25","2026-04-23","2026-04-23","2026-06-23","2026-06-23","2026-06-23","2026-06-23","2026-06-23","2026-06-23","2026-05-11","2026-02-26","2026-01-12","2026-04-09","2026-04-09","2026-01-16","2026-07-02","2026-07-02","2026-07-02","2026-05-15","2026-04-23","2026-04-23"],"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":[["","","OXYCODONE HYDROCHLORIDE","5000 MG","","Select","Select",""],["","","ESCITALOPRAM OXALATE","10000 MG","","Select","Select",""],["","","ONDANSETRON ODT","4000 MG","","Select","Select",""],["","","LORAZEPAM","500 MG","","Select","Select",""],["","","OMEPRAZOLE","40000 MG","","Select","Select",""],["","","MELOXICAM","15000 MG","","Select","Select",""],["","","ESTRADIOL","1000 MG","","Select","Select",""],["","","ONDANSETRON HYDROCHLORIDE","8000 MG","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","25 %","","Select","Select",""],["","","ELIQUIS","5000 MG","","Select","Select",""],["","","CLINDAMYCIN HYDROCHLORIDE","300000 MG","","Select","Select",""],["","","AMOXICILLIN","875000 MG","","Select","Select",""],["","","FUROSEMIDE","20000 MG","","Select","Select",""],["","","METOLAZONE","5000 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","0","","Select","Select",""],["","","BISOPROLOL FUMARATE\/HYDROCHLOROTHIAZIDE","0","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","10000 MG","","Select","Select",""],["","","DEXAMETHASONE","500 MG\/5ML","","Select","Select",""],["","","METOPROLOL TARTRATE","50000 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20000 MEQ","","Select","Select",""],["","","AMOXICILLIN\/CLAVULANATE POTASSIUM","0","","Select","Select",""],["","","CIPROFLOXACIN HYDROCHLORIDE","500000 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100000 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","10000 MG","","Select","Select",""],["","","JOURNAVX","50000 MG","","Select","Select",""],["","","FENTANYL","25000 MCG\/HR","","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":""}]}]}