{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Juanita Boyd Appling","gend":1,"currentgend":"","add":"2857 Sallywhite Rd","city":"Thomson","state":"GA","zip":"30824","dob":"1966-06-11","age":"","mstatus":"","insh":"0009076093001","cliId":"","pno":"7068256482","cno":"7068256482","email":"nitabappling@yahoo.com","ename":"","eno":"","pphy":"Kierston Prasatik","ppno":"7068146104","pcpadd":"4150 WASHINGTON RD STE 6","pcpcity":"EVANS","pcpstate":"GA","pcpzip":"30809","pcpcounty":"","pcpid":"","pcpname":"4150 WASHINGTON RD STE 6","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"2857 Sallywhite Rd","madd2":"","madd3":"","mcity":"Thomson","mstate":"GA","mzip":"30824","pcpfaxno":"","pcpnpi":"1598916272","currentgendcomment":"","pphycomment":"","uniqueid":"523569","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":["D70.9","I82.409","Z88.8","M15.9","R21","D72.819","D64.9","D70.8","I65.23","L20.89","L72.8","L28.1","F45.8","Z79.899","N93.8","N99.820","I10","E78.2","E66.01","Z68.27"],"date":["2026-03-13","2026-03-13","2026-03-13","2026-02-06","2026-02-06","2026-02-06","2026-03-13","2026-03-14","2026-06-16","2026-08-20","2026-08-20","2026-08-20","2026-08-20","2026-08-20","2026-04-02","2026-04-02","2026-06-16","2026-06-16","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":[["","","KETOCONAZOLE","2000 %","","Select","Select",""],["","","TACROLIMUS","100 %","","Select","Select",""],["","","AMMONIUM LACTATE","12000 %","","Select","Select",""],["","","NIFEDIPINE ER","30000 MG","","Select","Select",""],["","","CLOBETASOL PROPIONATE","50 %","","Select","Select",""],["","","MELOXICAM","7500 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","HYDROCORTISONE","2500 %","","Select","Select",""],["","","PERMETHRIN","5000 %","","Select","Select",""],["","","AMLODIPINE BESYLATE","10000 MG","","Select","Select",""],["","","METHOCARBAMOL","500000 MG","","Select","Select",""],["","","AZELASTINE HYDROCHLORIDE","137000 MCG\/SPRAY","","Select","Select",""],["","","LOSARTAN POTASSIUM","100000 MG","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","100 %","","Select","Select",""],["","","EBGLYSS","250000 MG\/2ML","","Select","Select",""],["","","BISOPROLOL FUMARATE\/HYDROCHLOROTHIAZIDE","0","","Select","Select",""],["","","CICLOPIROX NAIL LACQUER","8000 %","","Select","Select",""],["","","ACETAMINOPHEN\/CODEINE PHOSPHATE","0","","Select","Select",""],["","","VALACYCLOVIR HYDROCHLORIDE","500000 MG","","Select","Select",""],["","","FLUCONAZOLE","150000 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","20000 MEQ","","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":""}]}]}