{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charles Forey","gend":0,"currentgend":"","add":"486 Banks Chapel Rd NE","city":"Ranger","state":"GA","zip":"30734","dob":"1967-08-29","age":"","mstatus":"","insh":"0009069095001","cliId":"","pno":"7622315466","cno":"7622315466","email":"abccprga@outlook.com","ename":"","eno":"","pphy":"Ghada Kunter","ppno":"7066920603","pcpadd":"1020 J L WHITE DR STE 160","pcpcity":"JASPER","pcpstate":"GA","pcpzip":"30143","pcpcounty":"","pcpid":"","pcpname":"1020 J L WHITE DR STE 160","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"486 Banks Chapel Rd NE","madd2":"","madd3":"","mcity":"Ranger","mstate":"GA","mzip":"30734","pcpfaxno":"6785817109","pcpnpi":"1851566202","currentgendcomment":"","pphycomment":"","uniqueid":"515115","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":["M25.561","G89.29","M62.81","R26.89","M25.661"],"date":["2026-08-25","2026-08-18","2026-08-25","2026-08-25","2026-08-25"],"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":[["","","METHOCARBAMOL","750000 MG","","Select","Select",""],["","","JOURNAVX","50000 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50000 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","0","","Select","Select",""],["","","ELIQUIS","5000 MG","","Select","Select",""],["","","CELECOXIB","200000 MG","","Select","Select",""],["","","PREGABALIN","100000 MG","","Select","Select",""],["","","FOLIC ACID","1000 MG","","Select","Select",""],["","","IBUPROFEN","600000 MG","","Select","Select",""],["","","LINEZOLID","600000 MG","","Select","Select",""],["","","CYANOCOBALAMIN","1000000 MCG\/ML","","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":""}]}]}