{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kirstin Allison","gend":1,"currentgend":"","add":"631 W Broadacre Rd NW","city":"Dalton","state":"GA","zip":30721,"dob":"1992-10-15","age":"","mstatus":"","insh":"AS1004361001","cliId":"","pno":4233101046,"cno":4233101046,"email":"kallison10151992@gmail.com","ename":"","eno":"","pphy":"Alejandra Staubs","ppno":7065293245,"pcpadd":"1107 MEMORIAL DR STE G2","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"1107 MEMORIAL DR STE G2","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"631 W Broadacre Rd NW","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":30721,"pcpfaxno":7062726077,"pcpnpi":1013302561,"currentgendcomment":"","pphycomment":"","uniqueid":241442,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S82.892","R11.0","N30.01","M54.59","Z11.59","R53.83","Z34.81","Z3A.08","A08.8","R11.2","R19.7","Z01.419","Z30.09","E66.811","R30.0","R39.9","N30.00","B37.9","M25.571","B37.31","O44.33","Z3A.28","Z11.2","Z34.80","N91.2","Z87.59","Z13.79","J01.80","H66.93","S93.401","R09.81","J09.X2","R05.1","R07.0","Z00.00","Z76.89","Z68.33","O80","Z37.0","Z3A.40","O43.123","Z3A.39","N61.0","N91.1","Z32.01","Z3A.32","Z34.82","Z3A.20","O44.22","Z3A.36","Z39.2","O44.02","Z3A.24","Z34.83","O48.0","O26.893","N89.8","Z39.1","Z11.3","Z11.8","Z13.1","O36.813","K64.9","Z3A.00"],"date":["2025-03-02","2025-08-23","2025-08-23","2025-08-23","2025-08-23","2025-08-23","2023-02-15","2023-02-15","2025-07-07","2025-07-07","2025-07-07","2026-01-13","2026-01-13","2026-01-13","2025-07-14","2025-07-14","2025-07-14","2025-07-14","2025-03-04","2025-08-12","2023-07-05","2023-07-05","2023-02-15","2023-02-15","2023-01-25","2023-01-25","2023-02-27","2025-10-02","2025-10-02","2025-03-04","2025-03-27","2025-03-27","2025-03-27","2025-03-27","2025-05-30","2025-05-30","2025-05-30","2023-09-26","2023-09-26","2023-09-26","2023-09-20","2023-09-23","2024-07-27","2023-01-25","2023-01-25","2023-08-02","2023-09-05","2023-05-10","2023-05-10","2023-08-30","2023-10-25","2023-06-07","2023-06-07","2023-09-05","2023-09-25","2023-09-23","2023-09-23","2023-09-05","2023-02-15","2023-02-15","2023-06-07","2023-09-23","2023-09-29","2023-09-26"],"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":[["","","{28 Norethindrone","0.35 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Ibuprofen","600 MG","","Select","Select",""],["","","Promethazine Hydrochloride\/Dextromethorphan Hydrobromide","","","Select","Select",""],["","","{21 Ethinyl Estradiol","0.035 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Nystatin 100 Unt\/Mg Topical Powder","","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Progesterone","200 MG","","Select","Select",""],["","","Hydrocortisone","25 MG","","Select","Select",""],["","","Oseltamivir","75 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Fluticasone Propionate","","","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":""}]}]}