{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bailey lynn Janes","gend":1,"currentgend":"","add":"56 Mountain Lake Dr","city":"Jasper","state":"GA","zip":"30143","dob":"2007-06-12","age":"","mstatus":"","insh":"0009065733001","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"Nagamalar Raju","ppno":"7062992220","pcpadd":"1266 HIGHWAY 515 SOUTH","pcpcity":"JASPER","pcpstate":"GA","pcpzip":"30143","pcpcounty":"","pcpid":"","pcpname":"1266 HIGHWAY 515 SOUTH","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"56 Mountain Lake Dr","madd2":"","madd3":"","mcity":"Jasper","mstate":"GA","mzip":"30143","pcpfaxno":"7062532226","pcpnpi":"1285894188","currentgendcomment":"","pphycomment":"","uniqueid":"510137","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":["M54.50","Z90.49","R10.A2","R31.9","R11.14","R11.0","Z32.02","Z30.09","Z11.3","N39.0","R10.32","Z30.431","R10.20","G47.33","E03.9","E66.01","Z13.1","D50.8","D51.8","R53.83","N39.41","N83.291","Z97.5","Z79.899","Z30.46","N76.0","R32","N89.8","G47.8","R40.0","R51.9","F41.9","E66.813","R06.83","F32.A","R10.21","R10.23","Z30.430","N32.81","R39.14","F33.1","R30.0","G47.10","G47.00","Z82.0","Z87.440","R82.81","R80.9","K59.00","R10.9","B37.31","B96.89","Z01.89","R10.30","N30.00","R63.0","L85.3"],"date":["2026-07-12","2026-07-12","2026-01-16","2026-01-16","2026-05-18","2026-05-18","2026-06-11","2026-05-29","2026-05-29","2026-07-02","2026-07-02","2026-07-17","2026-07-17","2026-04-22","2026-02-26","2026-04-22","2026-02-26","2026-02-26","2026-02-26","2026-03-31","2026-07-28","2026-08-24","2026-08-16","2026-02-26","2026-04-28","2026-08-14","2026-01-06","2026-01-06","2026-03-31","2026-03-31","2026-03-31","2026-03-31","2026-03-31","2026-03-31","2026-03-31","2026-07-17","2026-08-24","2026-06-11","2026-04-27","2026-04-27","2026-03-16","2026-01-19","2026-03-27","2026-03-25","2026-03-25","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-07-12","2026-08-14","2026-08-14","2026-03-10","2026-07-12","2026-07-12","2026-02-06","2026-04-22"],"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":[["","","METRONIDAZOLE VAGINAL","750 %","","Select","Select",""],["","","DICYCLOMINE HYDROCHLORIDE","20000 MG","","Select","Select",""],["","","FAMOTIDINE","40000 MG","","Select","Select",""],["","","AZELASTINE HYDROCHLORIDE","137000 MCG\/SPRAY","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","100000 MCG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50000 MG","","Select","Select",""],["","","LAMOTRIGINE","25000 MG","","Select","Select",""],["","","ESCITALOPRAM OXALATE","10000 MG","","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100000 MG","","Select","Select",""],["","","MISOPROSTOL","200000 MCG","","Select","Select",""],["","","CEPHALEXIN","500000 MG","","Select","Select",""],["","","IBUPROFEN","800000 MG","","Select","Select",""],["","","PREDNISONE","20000 MG","","Select","Select",""],["","","FLUCONAZOLE","150000 MG","","Select","Select",""],["","","ESTRADIOL","10 %","","Select","Select",""],["","","CAPVAXIVE","500 ML","","Select","Select",""],["","","METRONIDAZOLE","500000 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","0","","Select","Select",""],["","","BUSPIRONE HCL","15000 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40000 MG","","Select","Select",""],["","","ONDANSETRON ODT","4000 MG","","Select","Select",""],["","","FLUZONE","0","","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":""}]}]}