{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lon Bartlett","gend":0,"currentgend":"","add":"447 Florence Ave","city":"Dalton","state":"GA","zip":"30720","dob":"1971-02-22","age":"","mstatus":"","insh":"0009079052001","cliId":"","pno":"7066184834","cno":"7064833585","email":"","ename":"","eno":"","pphy":"JEAN KLOCK","ppno":"7068639595","pcpadd":"3950 AUSTELL RD","pcpcity":"AUSTELL","pcpstate":"GA","pcpzip":"30106","pcpcounty":"","pcpid":"","pcpname":"3950 AUSTELL RD","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"447 Florence Ave","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":"30720","pcpfaxno":"7068688375","pcpnpi":"1275313884","currentgendcomment":"","pphycomment":"","uniqueid":"278068","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":["L03.221","T20.00X","R22.1","T22.10X","T31.0","F17.210","I10","R56.9","F10.20","E87.1","E83.51","I73.1","G40.909","F10.10","D53.9","B19.20","E88.09","Z79.899","D72.829","Z86.73","E66.3","F10.920","E87.6","K76.0","R94.31","R07.9","R52","S30.860","Z80.42","G40.89","R41.82","T20.29X","R00.0","T20.37X","T20.35X","T23.362","T22.312","T22.332","R07.81","F10.929","T23.001","T22.012","X12.XXX","R60.0","T20.27X","T22.112","I51.7","Z13.6","T20.30X","I23.1","S30.861","R53.81","Y99.8"],"date":["2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-05-22","2026-05-18","2026-08-19","2026-05-15","2026-05-15","2026-05-18","2026-05-18","2026-08-19","2026-08-19","2026-08-19","2026-05-18","2026-05-18","2026-05-18","2026-05-18","2026-05-18","2026-05-18","2026-05-18","2026-05-07","2026-05-07","2026-05-07","2026-05-08","2026-05-07","2026-05-07","2026-03-20","2026-03-20","2026-03-20","2026-05-10","2026-05-10","2026-05-12","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-22","2026-05-07","2026-05-07","2026-05-16","2026-05-16","2026-05-16","2026-05-15","2026-05-15","2026-05-15","2026-03-21","2026-05-08","2026-05-15","2026-05-08","2026-03-20","2026-03-20","2026-03-20"],"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":[["","","GABAPENTIN","300000 MG","","Select","Select",""],["","","ALPRAZOLAM","500 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100000 MG","","Select","Select",""],["","","MELOXICAM","15000 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10000 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE ER","10000 MEQ","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","10000 MG","","Select","Select",""],["","","LEVETIRACETAM","500000 MG","","Select","Select",""],["","","CARVEDILOL","6250 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","0","","Select","Select",""],["","","LISINOPRIL","20000 MG","","Select","Select",""],["","","METHOCARBAMOL","500000 MG","","Select","Select",""],["","","SILVER SULFADIAZINE","1000 %","","Select","Select",""],["","","CEPHALEXIN","500000 MG","","Select","Select",""],["","","IBUPROFEN","800000 MG","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","100 %","","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":""}]}]}