{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wendell L Cross","gend":0,"currentgend":"","add":"7710 Paradise Dr","city":"Donalsonville","state":"GA","zip":"39845","dob":"1967-02-20","age":"","mstatus":"","insh":"0009090006002","cliId":"","pno":"2293095736","cno":"2293095736","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"7710 Paradise Dr","madd2":"","madd3":"","mcity":"Donalsonville","mstate":"GA","mzip":"39845","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"541033","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":["D86.0","I10","E78.5","E03.9","Z12.5","M54.12","M89.9","C14.0","F11.20","G89.29","M54.2","M25.512","M54.59","M54.16","M54.17","M70.62","F41.1","Z79.899","C44.329","L57.8","L82.1","L81.4","D22.61","D48.5","L57.0","D22.62","Z85.828","Z85.89","Z86.018","R21","L60.3","R06.00","R60.0","M25.531","R23.3","R42","R41.3","H40.113","Z79.52","Z85.820","Z92.3"],"date":["2026-08-10","2026-08-17","2026-08-10","2026-08-10","2026-08-10","2026-07-27","2026-07-08","2026-08-10","2026-07-27","2026-07-27","2026-07-27","2026-07-27","2026-07-27","2026-07-27","2026-07-27","2026-07-27","2026-07-27","2026-07-27","2026-08-19","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-08","2026-07-08","2026-07-08","2026-07-08","2026-07-08","2026-07-08","2026-07-08","2026-07-08","2026-07-08","2026-07-08","2026-07-08","2026-07-08"],"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":[["","","LOSARTAN POTASSIUM","50000 MG","","Select","Select",""],["","","TRAMADOL HYDROCHLORIDE","50000 MG","","Select","Select",""],["","","HYDROXYZINE HYDROCHLORIDE","25000 MG","","Select","Select",""],["","","PREDNISONE","20000 MG","","Select","Select",""],["","","PILOCARPINE HYDROCHLORIDE","5000 MG","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","108000 MCG\/ACT","","Select","Select",""],["","","ATORVASTATIN CALCIUM","10000 MG","","Select","Select",""],["","","GABAPENTIN","800000 MG","","Select","Select",""],["","","MESALAMINE DR","1200 GM","","Select","Select",""],["","","BUSPIRONE HYDROCHLORIDE","15000 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":""}]}]}