{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Khristina Waldron","gend":1,"currentgend":"","add":"613 E Johnson St","city":"Quitman","state":"GA","zip":"31643","dob":"1975-06-01","age":"","mstatus":"","insh":"0009072386001","cliId":"","pno":"2293050647","cno":"2293050647","email":"khriswaldron220@gmail.com","ename":"","eno":"","pphy":"Jeffrey Lynch","ppno":"2292441400","pcpadd":"903 N COURT ST","pcpcity":"QUITMAN","pcpstate":"GA","pcpzip":"31643","pcpcounty":"","pcpid":"","pcpname":"903 N COURT ST","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"613 E Johnson St","madd2":"","madd3":"","mcity":"Quitman","mstate":"GA","mzip":"31643","pcpfaxno":"2292445512","pcpnpi":"1336224153","currentgendcomment":"","pphycomment":"","uniqueid":"519206","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":["M54.2","W19.XXX","K44.9","M54.9","E11.9","Z20.828","Z79.84","Z79.899","E83.42","R11.2","Z79.01","M48.02","D69.6","Z90.49","M51.369","E11.65","M87.851","K86.2","K85.90","S29.9XX","S39.92X","G40.309","M25.561","M50.33","G31.84","K86.0","R79.89","K86.89","I81","F10.20","I72.8","I86.8","Z87.19","R05.1","R41.3","Z87.898","M62.81","G47.00","Z71.1","R51.9","M25.551","M25.552","M70.71","M70.72","M48.062","M54.16","M51.362","M54.41","M54.42","M51.16","M51.17","M54.59","K86.1","M43.13","M79.10","Z20.822","S00.93X","R10.12","I87.8","Z96.641"],"date":["2026-02-12","2026-02-11","2026-02-11","2026-02-11","2026-08-10","2026-02-20","2026-06-09","2026-06-09","2026-03-21","2026-03-21","2026-06-09","2026-06-03","2026-06-09","2026-08-06","2026-08-06","2026-06-09","2026-08-06","2026-08-06","2026-08-06","2026-02-11","2026-02-11","2026-06-18","2026-07-23","2026-05-07","2026-08-03","2026-05-05","2026-05-08","2026-05-05","2026-05-05","2026-05-05","2026-05-05","2026-05-05","2026-05-05","2026-06-10","2026-08-10","2026-08-10","2026-04-08","2026-05-20","2026-07-28","2026-07-23","2026-02-06","2026-05-05","2026-02-06","2026-02-06","2026-05-05","2026-02-06","2026-05-05","2026-02-06","2026-02-06","2026-05-05","2026-03-03","2026-05-05","2026-03-21","2026-05-07","2026-02-20","2026-02-20","2026-07-23","2026-03-21","2026-03-21","2026-03-21"],"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":[["","","DICLOFENAC SODIUM DR","75000 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40000 MG","","Select","Select",""],["","","ELIQUIS","5000 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","50000 MG","","Select","Select",""],["","","TRUEPLUS LANCETS","0","","Select","Select",""],["","","ONDANSETRON ODT","4000 MG","","Select","Select",""],["","","PROMETHAZINE HYDROCHLORIDE","25000 MG","","Select","Select",""],["","","ACETAMINOPHEN\/CODEINE PHOSPHATE","0","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4000 MG","","Select","Select",""],["","","DULOXETINE HYDROCHLORIDE DR","30000 MG","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","5000 MG","","Select","Select",""],["","","CREON","0","","Select","Select",""],["","","BUPRENORPHINE HCL\/NALOXONE HCL","0","","Select","Select",""],["","","FOLIC ACID","1000 MG","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","0","","Select","Select",""],["","","DONEPEZIL HYDROCHLORIDE","5000 MG","","Select","Select",""],["","","DISULFIRAM","250000 MG","","Select","Select",""],["","","LEVETIRACETAM","500000 MG","","Select","Select",""],["","","FREESTYLE LITE TEST STRIPS","0","","Select","Select",""],["","","JARDIANCE","10000 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","0","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","AMOXICILLIN","500000 MG","","Select","Select",""],["","","IBUPROFEN","800000 MG","","Select","Select",""],["","","METFORMIN HYDROCHLORIDE","1000000 MG","","Select","Select",""],["","","BUTALBITAL\/ACETAMINOPHEN\/CAFFEINE","0","","Select","Select",""],["","","EMBECTA INSULIN SYRINGE ULTRA-FINE\/","0","","Select","Select",""],["","","HYDROXYZINE PAMOATE","50000 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50000 MG","","Select","Select",""],["","","HUMULIN N","100000 UNIT\/ML","","Select","Select",""],["","","CLEVER CHOICE COMFORT EZ INSULIN SYRINGE\/","0","","Select","Select",""],["","","DIAZEPAM","5000 MG","","Select","Select",""],["","","FREESTYLE LANCETS","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":""}]}]}