{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rhonda Petz","gend":1,"currentgend":"","add":"964 Seymour Ave","city":"Rossville","state":"GA","zip":"30741","dob":"1963-07-03","age":"","mstatus":"","insh":"0009085326001","cliId":"","pno":"7272778992","cno":"7272778992","email":"master070363@gmail.com","ename":"","eno":"","pphy":"Vincent Viscomi","ppno":"4234957378","pcpadd":"100 GROSS CRESCENT CIR","pcpcity":"FORT OGLETHORPE","pcpstate":"GA","pcpzip":"307423643","pcpcounty":"","pcpid":"","pcpname":"100 GROSS CRESCENT CIR","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"964 Seymour Ave","madd2":"","madd3":"","mcity":"Rossville","mstate":"GA","mzip":"30741","pcpfaxno":"4234954425","pcpnpi":"1982689493","currentgendcomment":"","pphycomment":"","uniqueid":"535252","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":["M99.03","M99.02","M99.01","M99.06","M54.12","Z79.891","M19.011","M47.816","K59.03","F33.3","G47.00","F60.3","F41.1","G89.4","G47.33","G47.30","I49.3","M48.061","M48.02","M16.12","J44.9","J30.89","K59.09","E78.2","Z11.59","Z11.4","Z91.89","G47.419","M47.812","G95.89","Z98.1"],"date":["2026-08-11","2026-08-11","2026-08-11","2026-08-11","2026-06-02","2026-08-04","2026-08-04","2026-08-04","2026-06-02","2026-06-30","2026-06-30","2026-06-30","2026-06-30","2026-08-04","2026-06-25","2026-06-10","2026-06-10","2026-05-05","2026-05-05","2026-05-05","2026-05-05","2026-05-05","2026-05-05","2026-05-05","2026-05-05","2026-05-05","2026-05-05","2026-06-11","2026-07-16","2026-07-16","2026-07-16"],"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":[["","","DULOXETINE HYDROCHLORIDE DR","60000 MG","","Select","Select",""],["","","MONTELUKAST SODIUM","10000 MG","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4000 MG","","Select","Select",""],["","","CARVEDILOL","25000 MG","","Select","Select",""],["","","ALPRAZOLAM","1000 MG","","Select","Select",""],["","","FLUTICASONE PROPIONATE\/SALMETEROL","0","","Select","Select",""],["","","MELOXICAM","15000 MG","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","5000 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50000 MG","","Select","Select",""],["","","ESCITALOPRAM OXALATE","10000 MG","","Select","Select",""],["","","AMPHETAMINE\/DEXTROAMPHETAMINE","0","","Select","Select",""],["","","DICYCLOMINE HYDROCHLORIDE","20000 MG","","Select","Select",""],["","","EZETIMIBE","10000 MG","","Select","Select",""],["","","TRELEGY ELLIPTA","0","","Select","Select",""],["","","OMEPRAZOLE","40000 MG","","Select","Select",""],["","","CAPLYTA","42000 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":""}]}]}