{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rebecca Jump","gend":1,"currentgend":"","add":"216 Griffin Ave","city":"Eastman","state":"GA","zip":"31023","dob":"1964-11-06","age":"","mstatus":"","insh":"0009062874001","cliId":"","pno":"4782879208","cno":"4782879208","email":"jumpbecky@yahoo.com","ename":"","eno":"","pphy":"Anilkumar Pillai","ppno":"4789224010","pcpadd":"155 COMMERCE ST","pcpcity":"HAWKINSVILLE","pcpstate":"GA","pcpzip":"31036","pcpcounty":"","pcpid":"","pcpname":"155 COMMERCE ST","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"216 Griffin Ave","madd2":"","madd3":"","mcity":"Eastman","mstate":"GA","mzip":"31023","pcpfaxno":"4789222821","pcpnpi":"1578519658","currentgendcomment":"","pphycomment":"","uniqueid":"505869","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":["M32.9","H16.223","I73.00","Z79.899","M25.511","M25.512","M54.2","M54.59","F11.10","I10","M13.0","Z51.81","Z68.35","F11.91","M79.672","M19.012","M19.011","Z13.31","Z68.37","D50.9","D51.9","D52.9","E78.2","K58.0","E55.9","I87.8","Z00.00","Z68.36"],"date":["2026-08-21","2026-08-21","2026-08-21","2026-08-21","2026-08-21","2026-08-21","2026-08-21","2026-08-21","2026-08-03","2026-08-03","2026-08-03","2026-08-03","2026-06-04","2026-01-12","2026-07-08","2026-08-21","2026-08-21","2026-07-02","2026-08-03","2026-02-11","2026-02-11","2026-02-11","2026-02-11","2026-02-11","2026-02-11","2026-02-11","2026-02-11","2026-01-12"],"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":[["","","DICLOFENAC POTASSIUM","50000 MG","","Select","Select",""],["","","BUPRENORPHINE HYDROCHLORIDE\/NALOXONE HYDROCHLORIDE","0","","Select","Select",""],["","","FLUTICASONE PROPIONATE","50000 MCG\/ACT","","Select","Select",""],["","","MUPIROCIN","2000 %","","Select","Select",""],["","","AMLODIPINE BESYLATE","2500 MG","","Select","Select",""],["","","CITALOPRAM HYDROBROMIDE","40000 MG","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","10000 MG","","Select","Select",""],["","","AZITHROMYCIN","250000 MG","","Select","Select",""],["","","HYDROXYZINE HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","LISINOPRIL","40000 MG","","Select","Select",""],["","","OMEPRAZOLE","40000 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":""}]}]}