{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert Simmons","gend":0,"currentgend":"","add":"3 Jefferson Pl","city":"Athens","state":"GA","zip":"30601","dob":"1976-03-02","age":"","mstatus":"","insh":"0009076117001","cliId":"","pno":"4787199863","cno":"4787199863","email":"","ename":"","eno":"","pphy":"Kilian Van Rijn","ppno":"7063538700","pcpadd":"120 HAWTHORNE PARK","pcpcity":"ATHENS","pcpstate":"GA","pcpzip":"30606","pcpcounty":"","pcpid":"","pcpname":"120 HAWTHORNE PARK","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3 Jefferson Pl","madd2":"","madd3":"","mcity":"Athens","mstate":"GA","mzip":"30601","pcpfaxno":"","pcpnpi":"1124523758","currentgendcomment":"","pphycomment":"","uniqueid":"523601","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":["S09.90X","R56.9","Z74.3","E11.65","Z79.01","F31.9","I10","I48.0","Z79.4","S00.83X","Z59.868","Z79.899","Z83.3","Z81.8","Z72.0","R33.9","Z86.718","I48.92","N17.9","E86.0","E11.49","E66.812","E11.51","R29.6","Z89.412","Z89.411","S91.114","S30.0XX","F17.290","Z71.6","Z68.34","Z91.148","Z91.81","E78.2","M19.011","T79.6XX","R53.1","I49.9","E11.10","I48.91","E87.1","R55","I71.02","R09.02","Z51.81","Z13.6","M75.81","M75.111","E11.42","M75.21","Z12.11","Z04.3","M79.643","S99.921","S29.9XX","S39.91X","E11.618","M75.01","F17.200","G89.11","S19.9XX","M47.812"],"date":["2026-05-23","2026-05-19","2026-05-19","2026-05-19","2026-05-19","2026-05-19","2026-08-19","2026-08-19","2026-08-19","2026-05-19","2026-05-19","2026-06-17","2026-05-19","2026-05-19","2026-05-19","2026-05-21","2026-05-19","2026-03-01","2026-03-03","2026-03-01","2026-03-02","2026-03-01","2026-03-01","2026-03-03","2026-03-01","2026-03-01","2026-03-01","2026-03-01","2026-03-01","2026-03-01","2026-03-01","2026-03-01","2026-03-01","2026-08-19","2026-06-03","2026-05-19","2026-05-19","2026-05-19","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-05-19","2026-06-17","2026-06-17","2026-08-06","2026-08-06","2026-08-19","2026-06-23","2026-08-19","2026-05-19","2026-05-19","2026-03-01","2026-03-01","2026-03-01","2026-05-15","2026-05-15","2026-03-02","2026-03-02","2026-03-01","2026-03-01"],"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":[["","","CYCLOBENZAPRINE HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","FLECAINIDE ACETATE","100000 MG","","Select","Select",""],["","","NOVOLOG FLEXPEN","100000 UNIT\/ML","","Select","Select",""],["","","TRESIBA FLEXTOUCH","100000 UNIT\/ML","","Select","Select",""],["","","DEXCOM G","0","","Select","Select",""],["","","GABAPENTIN","300000 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50000 MG","","Select","Select",""],["","","TAMSULOSIN HYDROCHLORIDE","400 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10000 MG","","Select","Select",""],["","","HYDRALAZINE HYDROCHLORIDE","50000 MG","","Select","Select",""],["","","ELIQUIS","5000 MG","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","40000 MG","","Select","Select",""],["","","HUMALOG KWIKPEN","100000 UNIT\/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":""}]}]}