{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy Grogan","gend":1,"currentgend":"","add":"935 W Spring Creek Rd","city":"Trion","state":"GA","zip":"30753","dob":"1962-11-29","age":"","mstatus":"","insh":"0009091919001","cliId":"","pno":"7068446805","cno":"7068446805","email":"","ename":"","eno":"","pphy":"Matthew Cornforth","ppno":"7068571010","pcpadd":"11766 HIGHWAY 27","pcpcity":"SUMMERVILLE","pcpstate":"GA","pcpzip":"30747","pcpcounty":"","pcpid":"","pcpname":"11766 HIGHWAY 27","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"935 W Spring Creek Rd","madd2":"","madd3":"","mcity":"Trion","mstate":"GA","mzip":"30753","pcpfaxno":"7068575638","pcpnpi":"1437180759","currentgendcomment":"","pphycomment":"","uniqueid":"482417","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":["Z51.81","F41.1","E78.2","I10","M48.062","M54.16","M51.362","F11.20","F45.42","F41.9","M25.512","M54.30","M25.511"],"date":["2026-08-12","2026-08-12","2026-08-12","2026-08-12","2026-07-16","2026-07-16","2026-07-16","2026-07-16","2026-07-16","2026-07-16","2026-07-16","2026-07-16","2026-07-20"],"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":[["","","MEXILETINE HYDROCHLORIDE","150000 MG","","Select","Select",""],["","","TIZANIDINE HYDROCHLORIDE","4000 MG","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","40000 MG","","Select","Select",""],["","","ALPRAZOLAM","1000 MG","","Select","Select",""],["","","SPIRONOLACTONE","25000 MG","","Select","Select",""],["","","CARVEDILOL","6250 MG","","Select","Select",""],["","","FUROSEMIDE","40000 MG","","Select","Select",""],["","","PRASUGREL HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","0","","Select","Select",""],["","","REPATHA SURECLICK","140000 MG\/ML","","Select","Select",""],["","","SACUBITRIL\/VALSARTAN","0","","Select","Select",""],["","","ASPIRIN ADULT LOW DOSE","81000 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":""}]}]}