{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Danielle Schneider","gend":1,"currentgend":"","add":"125 Jennings Mill Rd Apt 3209","city":"Athens","state":"GA","zip":"30606","dob":"1991-01-12","age":"","mstatus":"","insh":"0009082848001","cliId":"","pno":"7274882398","cno":"7274882398","email":"jeanhall260889@gmail.com","ename":"","eno":"","pphy":"Molla Teshome","ppno":"7702199000","pcpadd":"743 SPRING ST NE","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":"305013715","pcpcounty":"","pcpid":"","pcpname":"743 SPRING ST NE","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"125 Jennings Mill Rd Apt 3209","madd2":"","madd3":"","mcity":"Athens","mstate":"GA","mzip":"30606","pcpfaxno":"","pcpnpi":"1093039851","currentgendcomment":"","pphycomment":"","uniqueid":"532148","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":["J02.9","E03.9","F14.10","F12.90","F31.9","F41.1","F17.290","Z91.199","Z79.4","F11.20","F33.1","F43.10","F41.9","F90.9","E10.9","E10.40","G40.909","Z72.0","R65.21","E10.10","J96.01","J15.212","J96.02","I50.21","J85.0","G92.8","R29.732","R34","D72.819","I46.9","E10.22","N18.31","D63.1","I42.9","K59.39","N17.9","E87.5","K59.00","L03.211","F12.20","F31.81","F60.3","K92.2","D64.9","Z91.119","F19.10","F31.70","Z79.890","A41.9","R65.20","F13.10","F32.A","E16.A3","R78.81","B95.62","J18.9","F33.2","F42.2","F44.81","F51.01","J96.90","E87.20","E13.10","E11.649","G93.40","Z87.898","G93.41","R41.82","R07.9","E11.10","R73.9","N18.30","R06.02","D72.829","T38.3X6","Z91.128","Z91.148","R94.31","Z29.9","E11.65","F31.4","G93.89","I50.20","K59.81","E10.65","R68.89","Z74.3","R03.0","E16.2","R06.00","R53.81","R50.9","R45.1","I45.81","R74.01","R00.0","R40.0","I95.9","E87.21","I49.9","I34.0","I36.1","I33.0","E10.69","N17.8","R93.1","R41.0","N18.9","Z01.818","Z99.11","J18.8","F19.11","R53.83"],"date":["2026-05-11","2026-05-23","2026-05-11","2026-05-11","2026-05-23","2026-05-11","2026-05-11","2026-05-11","2026-05-23","2026-05-06","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-06","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-24","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-24","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-04-09","2026-03-27","2026-03-27","2026-03-27","2026-04-26","2026-05-11","2026-04-26","2026-05-15","2026-04-26","2026-04-26","2026-05-13","2026-05-12","2026-03-04","2026-03-04","2026-03-14","2026-05-23","2026-05-23","2026-05-17","2026-03-22","2026-03-22","2026-03-22","2026-03-22","2026-05-20","2026-05-20","2026-05-19","2026-03-14","2026-05-15","2026-05-15","2026-05-23","2026-05-18","2026-05-11","2026-05-15","2026-04-26","2026-05-22","2026-05-11","2026-04-03","2026-04-03","2026-04-03","2026-04-03","2026-04-03","2026-04-03","2026-04-25","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-05-23","2026-03-14","2026-05-11","2026-03-13","2026-05-11","2026-05-11","2026-05-11","2026-05-11","2026-05-16","2026-03-30","2026-03-30","2026-05-10","2026-04-25","2026-05-13","2026-05-13","2026-05-24","2026-05-15","2026-05-15","2026-05-15","2026-04-26","2026-05-23","2026-05-23","2026-05-18","2026-05-18","2026-05-15","2026-05-15","2026-05-15","2026-05-15","2026-03-14"],"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":[["","","INSULIN GLARGINE-YFGN","100000 UNIT\/ML","","Select","Select",""],["","","CLONIDINE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","ONDANSETRON ODT","4000 MG","","Select","Select",""],["","","NOVOLOG FLEXPEN","100000 UNIT\/ML","","Select","Select",""],["","","LORAZEPAM","2000 MG","","Select","Select",""],["","","METHOCARBAMOL","500000 MG","","Select","Select",""],["","","ATOMOXETINE","80000 MG","","Select","Select",""],["","","BUSPIRONE HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","FLUOXETINE HYDROCHLORIDE","20000 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","150000 MG","","Select","Select",""],["","","PREGABALIN","100000 MG","","Select","Select",""],["","","VRAYLAR","1500 MG","","Select","Select",""],["","","EMBECTA PEN NEEDLE\/NANO","0","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","0","","Select","Select",""],["","","MUPIROCIN","2000 %","","Select","Select",""],["","","QUETIAPINE FUMARATE","400000 MG","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","100000 MCG","","Select","Select",""],["","","OXCARBAZEPINE","300000 MG","","Select","Select",""],["","","DICYCLOMINE HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","HYDROXYZINE PAMOATE","50000 MG","","Select","Select",""],["","","PROPRANOLOL HYDROCHLORIDE ER","60000 MG","","Select","Select",""],["","","PRIMIDONE","50000 MG","","Select","Select",""],["","","ATOMOXETINE HYDROCHLORIDE","80000 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12500 MG","","Select","Select",""],["","","LAMOTRIGINE","25000 MG","","Select","Select",""],["","","AZITHROMYCIN","250000 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":""}]}]}