{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Heather Slagle","gend":1,"currentgend":"","add":"3025 Rogers Mill Rd","city":"Danielsville","state":"GA","zip":"30633","dob":"1984-03-04","age":"","mstatus":"","insh":"0009083741001","cliId":"","pno":"7064244781","cno":"7064244781","email":"heathermarieslagle84@gmail.com","ename":"","eno":"","pphy":"Chundra Brooks","ppno":"7063532990","pcpadd":"1460 RESURGENCE DR","pcpcity":"WATKINSVILLE","pcpstate":"GA","pcpzip":"30677","pcpcounty":"","pcpid":"","pcpname":"1460 RESURGENCE DR","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3025 Rogers Mill Rd","madd2":"","madd3":"","mcity":"Danielsville","mstate":"GA","mzip":"30633","pcpfaxno":"7063532992","pcpnpi":"1699116624","currentgendcomment":"","pphycomment":"","uniqueid":"533314","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":["D75.89","E83.51","D59.10","R79.82","K59.00","R19.4","Z80.0","R92.8","Z00.00","E03.9","R76.89","E53.8","H40.033","H16.231","B00.52","Z12.31","Z80.3","F41.1","L71.9","K59.01","Z01.89","R10.9"],"date":["2026-04-08","2026-04-08","2026-04-08","2026-04-08","2026-07-28","2026-07-28","2026-07-28","2026-03-26","2026-04-02","2026-08-19","2026-04-02","2026-08-03","2026-08-11","2026-08-11","2026-08-11","2026-03-23","2026-03-23","2026-05-11","2026-03-25","2026-06-09","2026-07-28","2026-06-09"],"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":[["","","LEVOTHYROXINE SODIUM","88000 MCG","","Select","Select",""],["","","MINOCYCLINE HYDROCHLORIDE","100000 MG","","Select","Select",""],["","","METRONIDAZOLE","750 %","","Select","Select",""],["","","IVERMECTIN","1000 %","","Select","Select",""],["","","HYDROXYZINE HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","FOLIC ACID","1000 MG","","Select","Select",""],["","","CLOBETASOL PROPIONATE","50 %","","Select","Select",""],["","","KETOCONAZOLE","2000 %","","Select","Select",""],["","","AMOXICILLIN","500000 MG","","Select","Select",""],["","","GAVILYTE-G","0","","Select","Select",""],["","","AZITHROMYCIN","250000 MG","","Select","Select",""],["","","METHYLPREDNISOLONE DOSE PACK","4000 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":""}]}]}