{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charles West Holtzclaw","gend":0,"currentgend":"","add":"2661 Old Ocilla Rd","city":"Tifton","state":"GA","zip":"31794","dob":"1972-07-07","age":"","mstatus":"","insh":"0009070183001","cliId":"","pno":"2295208283","cno":"2295208283","email":"holtzclawwest@gmail.com","ename":"","eno":"","pphy":"Brittney Berckman","ppno":"2293914100","pcpadd":"2225 US HIGHWAY 41 N","pcpcity":"TIFTON","pcpstate":"GA","pcpzip":"31794","pcpcounty":"","pcpid":"","pcpname":"2225 US HIGHWAY 41 N","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"2661 Old Ocilla Rd","madd2":"","madd3":"","mcity":"Tifton","mstate":"GA","mzip":"31794","pcpfaxno":"","pcpnpi":"1114189230","currentgendcomment":"","pphycomment":"","uniqueid":"516545","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":["Z79.899","K21.9","G47.00","K74.60","F41.9","E78.1","F10.11","D64.9","F10.90","D69.6","F10.10","E83.42","E87.6","F10.20","F32.A","F41.1","G89.29","K70.30","K76.82","M70.22","F10.929","F10.980","Z63.79"],"date":["2026-05-06","2026-02-25","2026-02-25","2026-02-27","2026-02-25","2026-02-25","2026-02-25","2026-02-25","2026-04-01","2026-04-03","2026-05-05","2026-04-03","2026-04-03","2026-04-08","2026-04-08","2026-04-08","2026-04-08","2026-06-16","2026-04-08","2026-04-08","2026-05-05","2026-06-16","2026-06-16"],"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":[["","","XIFAXAN","550000 MG","","Select","Select",""],["","","DIAZEPAM","5000 MG","","Select","Select",""],["","","LACTULOSE","10000 GM\/15ML","","Select","Select",""],["","","VILAZODONE HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","LORAZEPAM","500 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":""}]}]}