{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brenda Wood","gend":1,"currentgend":"","add":"13 Howington Rd","city":"Jefferson","state":"GA","zip":"30549","dob":"1963-01-18","age":"","mstatus":"","insh":"0009071572001","cliId":"","pno":"7708643506","cno":"7708643506","email":"kayewood63@yahoo.com","ename":"","eno":"","pphy":"Ari Levine","ppno":"7708674146","pcpadd":"314 N BROAD ST STE 250","pcpcity":"WINDER","pcpstate":"GA","pcpzip":"30680","pcpcounty":"","pcpid":"","pcpname":"314 N BROAD ST STE 250","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"13 Howington Rd","madd2":"","madd3":"","mcity":"Jefferson","mstate":"GA","mzip":"30549","pcpfaxno":"7708673742","pcpnpi":"1235526211","currentgendcomment":"","pphycomment":"","uniqueid":"518225","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":["K80.10","R00.1","I10","K82.9","E11.9","M06.9","K21.9","E03.9","E78.5","G25.81","I45.10","E83.42","G43.909","Z79.4","Z79.84","Z79.899","Z11.52","K81.1","R11.2","N17.9","M05.89","E87.20","E11.42","I95.9","E87.1","F17.290","Z90.49","K31.89","R19.7","K29.70","K75.81","K74.69","K80.50","G89.18","R10.9","N13.30","K80.20","G89.4","F11.90","G89.29","R10.11","M05.79","Z68.30","R13.10","K76.0","K74.00","Z86.010","R10.84","R42","R53.1","Z01.818","E78.2","E66.811","M06.061","M06.062","E66.09","Z87.19","A41.9","J44.9","M05.9","R11.0","F41.9","H91.93","R06.00","R41.82"],"date":["2026-03-24","2026-03-07","2026-06-15","2026-03-07","2026-06-15","2026-03-07","2026-04-14","2026-03-07","2026-03-30","2026-03-07","2026-03-29","2026-03-07","2026-03-07","2026-03-07","2026-03-30","2026-03-30","2026-03-07","2026-03-24","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-03-30","2026-07-10","2026-04-14","2026-02-03","2026-04-14","2026-02-03","2026-03-24","2026-03-29","2026-04-14","2026-03-07","2026-03-07","2026-06-15","2026-02-20","2026-02-20","2026-03-30","2026-06-15","2026-06-15","2026-04-14","2026-04-14","2026-04-14","2026-04-14","2026-03-29","2026-03-06","2026-03-29","2026-03-11","2026-06-15","2026-03-11","2026-03-11","2026-03-11","2026-03-11","2026-03-06","2026-03-29","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-03-06","2026-03-06"],"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":[["","","OXYCODONE\/ACETAMINOPHEN","0","","Select","Select",""],["","","PROPRANOLOL HYDROCHLORIDE","20000 MG","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4000 MG","","Select","Select",""],["","","GABAPENTIN","300000 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","80000 MG","","Select","Select",""],["","","ONDANSETRON ODT","8000 MG","","Select","Select",""],["","","CLONAZEPAM ODT","500 MG","","Select","Select",""],["","","COLESTIPOL HYDROCHLORIDE","1000 GM","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000000 MG","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","200000 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","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":""}]}]}