{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Laura E Heath","gend":1,"currentgend":"","add":"40 Bluegrass Blvd SE","city":"Rome","state":"GA","zip":30161,"dob":"1973-01-15","age":"","mstatus":"","insh":"AS1001943002","cliId":"","pno":7062916950,"cno":7062916950,"email":"laurapt@aol.com","ename":"","eno":"","pphy":"Paula Tanasa","ppno":4042555956,"pcpadd":"980 JOHNSON FERRY RD STE 220","pcpcity":"ATLANTA","pcpstate":"GA","pcpzip":30342,"pcpcounty":"","pcpid":"","pcpname":"980 JOHNSON FERRY RD STE 220","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"40 Bluegrass Blvd SE","madd2":"","madd3":"","mcity":"Rome","mstate":"GA","mzip":30161,"pcpfaxno":4042553908,"pcpnpi":1386650828,"currentgendcomment":"","pphycomment":"","uniqueid":234930,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42","H81.01","M51.360","E46","K59.04","R63.4","E03.9","E55.9","Z12.11","L50.1","J30.9","H10.13","Z91.018","R21","D89.40","K21.9","K22.89","K58.9","K59.02","E06.3","F41.9","G47.00","Z91.040","Z88.8","Z88.3","Z88.5","Z79.899","Z79.890","Z79.810","R11.0","E34.9","N95.1","Z87.898","H43.813","F41.1","F43.29","L23.0","K59.00","I95.1","K29.50","R00.2","L68.9","D89.89","K31.84","R10.9","R19.8","R14.0","Z90.49","H35.371","H35.033","H52.13","H31.093","Z12.31","G56.03","M79.602","M79.601","R20.2","Z78.0","R63.6","Z13.820","K90.9","E04.1","E03.8","D72.818","Z00.00","D72.829","R53.83","H35.412","H33.312","K80.20","K63.89","G90.A","G62.9","R63.5","M25.59","Z01.89","K59.09","N39.8","N39.3","K56.41","N81.84","L23.9","E86.1","H91.93","K80.10","R39.15","R35.0","N39.46","N95.2","N81.10","N81.6","R35.1","R93.89","M47.816","H33.322","R41.89","F90.0","Z01.818","R53.81","R10.13","Z13.6","Z13.1","E34.8","E23.0","Z88.1","H93.13","Z11.51","Z01.419","Z03.89","D70.8","H93.19","D47.09","F51.04","R00.0","H93.11","M54.50","G89.29","I34.0","L82.1","D22.5","L81.4","K29.70","Z13.31","G54.1","R06.83","G47.10","D70.9","H10.10","E04.2","K82.8","R10.84","R53.1","I78.1","L81.8","L70.0","L85.3","D17.1","E74.10","R14.3","H43.811","M62.89","R30.0","Z87.442","R13.10","Z90.710","H43.392","H35.031","M99.04","D72.819","L25.9","H69.83","K58.1","N89.8","H43.812","M48.07","N95.8","E89.40","T75.3XX","H60.543","T18.9XX","H90.11","H61.21","E87.8","H91.8X3","K59.89","R76.8","M24.9","H43.393","H53.8","R29.2","R19.4","Z80.0","H35.413","R27.8","R10.2","K62.89","R93.5","H81.09","H83.2X9","R76.89","K90.49","M35.9","H92.01","H11.153","Z83.71"],"date":["2026-01-12","2026-02-24","2026-01-12","2025-09-02","2026-03-09","2025-09-02","2026-01-05","2025-09-02","2023-02-06","2026-03-19","2026-02-19","2026-02-19","2026-02-19","2025-11-18","2026-03-09","2024-11-26","2025-01-22","2026-02-19","2026-03-09","2026-02-25","2025-01-22","2025-08-26","2025-08-17","2025-01-22","2025-01-22","2026-02-02","2025-12-08","2026-01-05","2025-01-22","2025-12-08","2026-01-05","2025-08-26","2025-01-09","2026-02-17","2026-03-17","2026-03-17","2025-03-10","2025-11-19","2026-03-12","2023-12-01","2025-12-09","2026-01-05","2025-09-30","2026-03-12","2026-02-09","2024-08-12","2025-08-13","2025-08-17","2026-02-17","2025-09-30","2025-09-30","2025-09-30","2025-04-01","2024-08-08","2024-08-08","2024-08-08","2024-08-08","2025-04-01","2024-02-27","2024-02-27","2026-02-24","2026-02-24","2024-12-09","2024-12-09","2024-12-09","2023-10-13","2026-03-12","2025-11-25","2026-02-17","2024-11-18","2023-02-06","2026-03-09","2026-03-09","2023-08-22","2025-09-30","2023-07-24","2026-02-19","2025-12-01","2025-12-01","2025-12-01","2025-12-01","2025-02-06","2025-09-24","2025-06-13","2025-03-03","2024-07-10","2024-07-10","2024-07-10","2024-07-10","2024-07-10","2025-03-24","2024-07-10","2026-03-02","2025-09-30","2026-02-17","2026-03-12","2025-12-10","2024-12-31","2025-06-03","2024-11-18","2023-09-21","2023-09-21","2023-10-12","2023-10-12","2026-02-02","2025-06-03","2023-02-15","2025-04-01","2025-01-22","2024-12-11","2025-07-30","2026-01-05","2026-01-05","2026-03-12","2025-12-23","2025-09-30","2025-09-30","2024-07-01","2025-04-16","2025-04-16","2025-04-16","2025-01-22","2025-04-01","2024-08-12","2023-11-27","2023-11-27","2023-11-27","2023-07-27","2024-03-28","2024-12-09","2025-08-17","2024-12-11","2023-04-20","2023-04-20","2023-04-20","2023-04-20","2023-04-20","2024-10-31","2024-10-31","2025-06-24","2024-06-25","2025-07-24","2025-05-21","2025-12-08","2026-02-02","2025-06-24","2025-03-04","2025-09-02","2024-04-04","2025-03-14","2025-03-14","2026-02-02","2024-03-29","2025-08-04","2025-09-30","2024-03-29","2024-04-04","2024-04-04","2023-11-07","2025-06-13","2025-04-22","2025-04-22","2025-04-22","2025-06-13","2024-09-05","2025-09-30","2025-10-15","2023-10-02","2023-10-02","2023-11-07","2023-01-31","2023-02-22","2026-02-17","2025-08-11","2024-06-25","2024-08-12","2024-08-12","2025-07-30","2025-07-30","2025-10-15","2023-07-24","2023-07-24","2025-06-03","2024-11-26","2023-02-22"],"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":[["","","Liothyronine Sodium","0.005 MG","","Select","Select",""],["","","Rifaximin","550 MG","","Select","Select",""],["","","Prednisolone Acetate","10 MG","","Select","Select",""],["","","Tenapanor","50 MG","","Select","Select",""],["","","Doxepin","25 MG","","Select","Select",""],["","","Bethanechol Chloride","25 MG","","Select","Select",""],["","","Estradiol","0.1 MG","","Select","Select",""],["","","84 Hr Estradiol","0.00417 MG","","Select","Select",""],["","","Progesterone","100 MG","","Select","Select",""],["","","Nortriptyline Hcl","25 MG","","Select","Select",""],["","","Carvedilol","3.125 MG","","Select","Select",""],["","","Synthroid","137 MCG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Amphetamine Aspartate","2.5 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Betamethasone","0.0005 MG","","Select","Select",""],["","","Azelastine Hydrochloride","0.137 MG","","Select","Select",""],["","","Metoprolol Tartrate","25 MG","","Select","Select",""],["","","Promethazine Hydrochloride","25 MG","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","Cromolyn Sodium","20 MG","","Select","Select",""],["","","Metoclopramide Hydrochloride","","","Select","Select",""],["","","Prucalopride","2 MG","","Select","Select",""],["","","Linzess","","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Midodrine Hydrochloride","","","Select","Select",""],["","","Amphetamine\/Dextroamphetamine","","","Select","Select",""],["","","Prochlorperazine","10 MG","","Select","Select",""],["","","Epinephrine","","","Select","Select",""],["","","Levothyroxine Sodium","0.125 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Fludrocortisone Acetate","","","Select","Select",""],["","","Lactulose","10 GM","","Select","Select",""],["","","Metoclopramide","5 MG","","Select","Select",""],["","","72 Hr Scopolamine","0.0139 MG","","Select","Select",""],["","","Triamcinolone Acetonide","1 MG","","Select","Select",""],["","","Lubiprostone","0.024 MG","","Select","Select",""],["","","Misoprostol","0.1 MG","","Select","Select",""],["","","Hydrocodone\/Acetaminophen","","","Select","Select",""],["","","Ibuprofen","600 MG","","Select","Select",""],["","","Clobetasol Propionate","0.5 MG","","Select","Select",""],["","","Levocetirizine Dihydrochloride","5 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Nortriptyline","10 MG","","Select","Select",""],["","","Lisdexamfetamine Dimesylate","","","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":""}]}]}