{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lora Wells","gend":1,"currentgend":"","add":"266 Pointe Cir","city":"Dahlonega","state":"GA","zip":"30533","dob":"1964-05-14","age":"","mstatus":"","insh":"0009055313001","cliId":"","pno":"7067010970","cno":"7067010970","email":"lorywells@yahoo.com","ename":"","eno":"","pphy":"Katia Adams","ppno":"7062163238","pcpadd":"108 PROMINENCE CT STE 200","pcpcity":"DAWSONVILLE","pcpstate":"GA","pcpzip":"30534","pcpcounty":"","pcpid":"","pcpname":"108 PROMINENCE CT STE 200","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"266 Pointe Cir","madd2":"","madd3":"","mcity":"Dahlonega","mstate":"GA","mzip":"30533","pcpfaxno":"7062165285","pcpnpi":"1649224114","currentgendcomment":"","pphycomment":"","uniqueid":"495651","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":["R26.9","R29.898","R26.81","S93.402","Z11.59","E78.5","E03.9","R73.03","Z00.01","Z23","Z11.4","Z20.828","Z12.31","G47.09","Z68.33","M70.21","F51.01","Z91.030","I83.813","Z68.32","M25.522","M70.22","R22.32","Z68.31","G47.33","L23.9","D23.71","D18.01","L81.4","I10","R42","K51.50","H83.3X3","R17"],"date":["2026-06-10","2026-06-10","2026-06-10","2026-05-28","2026-04-21","2026-07-27","2026-04-15","2026-07-06","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-04-21","2026-08-17","2026-07-09","2026-07-27","2026-03-02","2026-03-02","2026-07-27","2026-07-09","2026-07-09","2026-07-09","2026-07-09","2026-08-05","2026-08-13","2026-08-13","2026-08-13","2026-08-13","2026-08-17","2026-08-17","2026-07-27","2026-08-17","2026-01-28"],"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":[["","","BUDESONIDE","3000 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","20000 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","50000 MCG","","Select","Select",""],["","","ESZOPICLONE","2000 MG","","Select","Select",""],["","","URSODIOL","500000 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500000 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","5000 MG","","Select","Select",""],["","","FLUBLOK","0","","Select","Select",""],["","","COMIRNATY","30000 MCG\/0.3ML","","Select","Select",""],["","","EPINEPHRINE","300 MG\/0.3ML","","Select","Select",""],["","","MESALAMINE DR","1200 GM","","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":""}]}]}