{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Claude Wilkes","gend":0,"currentgend":"","add":"3830 Belair Rd","city":"Augusta","state":"GA","zip":"30909","dob":"1968-04-01","age":"","mstatus":"","insh":"0009084172001","cliId":"","pno":"7064141283","cno":"7064141283","email":"","ename":"","eno":"","pphy":"Kirsten Titus","ppno":"7068639595","pcpadd":"3651 WHEELER RD","pcpcity":"AUGUSTA","pcpstate":"GA","pcpzip":"30909","pcpcounty":"","pcpid":"","pcpname":"3651 WHEELER RD","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"3830 Belair Rd","madd2":"","madd3":"","mcity":"Augusta","mstate":"GA","mzip":"30909","pcpfaxno":"","pcpnpi":"1265209688","currentgendcomment":"","pphycomment":"","uniqueid":"533829","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":["T23.202","T23.201","Z79.899","Z79.2","D72.823","E66.9","E78.5","E83.51","F15.90","G47.33","G89.11","N40.0","R09.02","T31.0","Z68.31","Z98.1","I12.9","N18.30","T52.0X1","F17.210","T20.20X","T22.211","T22.212","T23.262","T23.272","T23.271","F17.200","R30.0","S51.041","W57.XXX","T20.00X","S29.8XX","T23.209","T30.0"],"date":["2026-06-14","2026-06-25","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-14","2026-06-25","2026-06-14","2026-06-14","2026-06-25","2026-06-25","2026-06-25","2026-06-25","2026-07-19","2026-04-23","2026-04-23","2026-06-14","2026-06-14","2026-06-14","2026-06-14"],"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":[["","","CEPHALEXIN","500000 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40000 MG","","Select","Select",""],["","","FUROSEMIDE","20000 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":""}]}]}