{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beverly Bettis","gend":1,"currentgend":"","add":"233 Bartow Way","city":"Cohutta","state":"GA","zip":"30710","dob":"1978-02-06","age":"","mstatus":"","insh":"0009084691001","cliId":"","pno":"7065377356","cno":"7065377356","email":"beverlybettis@gmail.com","ename":"","eno":"","pphy":"Lucy AUSDRAN","ppno":"4232807636","pcpadd":"1200 MEMORIAL DR","pcpcity":"DALTON","pcpstate":"GA","pcpzip":"30720","pcpcounty":"","pcpid":"","pcpname":"1200 MEMORIAL DR","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"233 Bartow Way","madd2":"","madd3":"","mcity":"Cohutta","mstate":"GA","mzip":"30710","pcpfaxno":"","pcpnpi":"1811467350","currentgendcomment":"","pphycomment":"","uniqueid":"534449","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":["I25.10","I10","E78.2","E11.65","E11.42","J45.40","Z12.31","R93.1","F41.8","M19.032","M25.532","J44.89","F41.0","E66.813","Z68.42","F17.210","Z01.419","Z79.890","M17.0","M25.561","M25.562","F33.1","F41.1","Z79.899","I49.8","R00.1","Z13.6","R07.2","I51.7","I36.1","M47.812","M79.10","G89.4","M25.512","K59.03","Z79.891","F40.231","R07.9","R07.89","M54.12","M47.817","R94.31","I23.1","M85.832"],"date":["2026-07-01","2026-07-01","2026-07-16","2026-07-01","2026-06-01","2026-06-01","2026-07-24","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-06-15","2026-06-24","2026-06-24","2026-07-28","2026-06-29","2026-06-29","2026-06-09","2026-06-09","2026-06-09","2026-06-15","2026-06-15","2026-06-16","2026-06-15","2026-06-15","2026-06-15","2026-07-28","2026-07-28","2026-07-28","2026-05-21","2026-05-21","2026-07-28","2026-04-29","2026-06-15","2026-06-15","2026-07-28","2026-07-28","2026-06-16","2026-06-16","2026-06-15"],"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":[["","","MOUNJARO","15000 MG\/0.5ML","","Select","Select",""],["","","LAMOTRIGINE","150000 MG","","Select","Select",""],["","","ESTRADIOL","1000 MG","","Select","Select",""],["","","PROGESTERONE","100000 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","0","","Select","Select",""],["","","SYMBICORT","0","","Select","Select",""],["","","MONTELUKAST SODIUM","10000 MG","","Select","Select",""],["","","GABAPENTIN","300000 MG","","Select","Select",""],["","","CELECOXIB","100000 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","108000 MCG\/ACT","","Select","Select",""],["","","LISINOPRIL","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":""}]}]}