{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jennifer Sanders","gend":1,"currentgend":"","add":"581 Greensboro Rd","city":"Eatonton","state":"GA","zip":"31024","dob":"1981-08-22","age":"","mstatus":"","insh":"0009065016001","cliId":"","pno":"7064731607","cno":"7064731607","email":"j.g.sanders@hotmail.com","ename":"","eno":"","pphy":"Paul Raber","ppno":"7067520322","pcpadd":"1550 EATONTON RD","pcpcity":"MADISON","pcpstate":"GA","pcpzip":"30650","pcpcounty":"","pcpid":"","pcpname":"1550 EATONTON RD","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"581 Greensboro Rd","madd2":"","madd3":"","mcity":"Eatonton","mstate":"GA","mzip":"31024","pcpfaxno":"9783277921","pcpnpi":"1740394428","currentgendcomment":"","pphycomment":"","uniqueid":"380575","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":["M79.671","M53.3","M54.2","M79.641","M54.50","G89.29","M54.41","L40.9","Z51.81","Z79.1","Z79.631","Z79.620","R07.9","R06.02","R51.9","R42","S29.011","L40.50","Z11.59","Z11.1","E78.2","M79.672","M79.642"],"date":["2026-05-18","2026-05-18","2026-05-18","2026-05-18","2026-05-18","2026-05-18","2026-05-18","2026-06-08","2026-06-08","2026-06-08","2026-06-08","2026-06-08","2026-05-06","2026-05-06","2026-05-06","2026-05-06","2026-05-06","2026-06-08","2026-03-05","2026-03-05","2026-02-04","2026-05-18","2026-05-18"],"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":[["","","METHOTREXATE SODIUM","2500 MG","","Select","Select",""],["","","AZITHROMYCIN","250000 MG","","Select","Select",""],["","","GABAPENTIN","100000 MG","","Select","Select",""],["","","ADALIMUMAB-ADAZ","40000 MG\/0.4ML","","Select","Select",""],["","","CELECOXIB","200000 MG","","Select","Select",""],["","","FOLIC ACID","1000 MG","","Select","Select",""],["","","PITAVASTATIN CALCIUM","1000 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4000 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":""}]}]}