{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kimberly A Lopez","gend":1,"currentgend":"","add":"924 Nelson Kile Rd NE","city":"Dalton","state":"GA","zip":30721,"dob":"1992-02-15","age":"","mstatus":"","insh":"AS1006744001","cliId":"","pno":5735288582,"cno":5735288582,"email":"kiml.7178@gmail.com","ename":"","eno":"","pphy":"Timothy Snodgrass","ppno":7065293245,"pcpadd":"1012 BURLEYSON RD","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"1012 BURLEYSON RD","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"924 Nelson Kile Rd NE","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":30721,"pcpfaxno":7062726077,"pcpnpi":1962484055,"currentgendcomment":"","pphycomment":"","uniqueid":358214,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R93.89","E28.2","N93.8","R73.03","N85.2","K74.60","Z90.89","Z98.890","Z88.2","Z83.3","Z68.34","Z01.810","R30.0","R73.09","E78.2","R39.9","B96.0","R11.2","R05.8","R52","Z32.02","R00.0","R50.9","R65.10","R42","R68.89","B34.9","Z03.818","F43.23","E55.9","Z00.00","E53.8","K21.9","R53.83","Z01.419","E11.65","E78.1","K76.0","N84.0","Z11.3","J15.7","Z86.79","J18.9","Z11.51","Z11.8","Z01.818","Z03.89","R10.9","M62.830","J06.9","M94.0","R07.9","L70.8","R94.31","D23.71","I21.4","Z13.6","N85.8"],"date":["2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2025-10-20","2025-10-20","2026-02-17","2025-10-20","2024-09-05","2024-09-05","2024-09-05","2024-09-05","2024-09-05","2024-09-06","2024-09-05","2024-09-05","2024-09-05","2024-09-05","2024-09-03","2024-09-05","2025-06-17","2024-02-22","2024-02-22","2024-02-22","2024-02-22","2024-02-22","2023-02-01","2026-02-17","2026-02-17","2026-02-17","2023-04-11","2023-02-01","2024-09-11","2024-09-11","2024-09-05","2023-02-01","2023-02-01","2023-04-10","2023-04-10","2023-03-17","2023-03-17","2023-03-09","2023-03-09","2023-03-09","2023-08-16","2024-09-06","2023-08-16","2024-09-05","2024-09-05","2023-04-11"],"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":[["","","Spironolactone","50 MG","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 5-325","","","Select","Select",""],["","","Dexamethasone","4 MG","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","0.5 Ml Influenza A Virus A\/Darwin\/6\/2021 H3N2 Antigen","0.03 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Jardiance","","","Select","Select",""],["","","3 Ml Insulin Glargine-Yfgn 100 Unt\/Ml Pen Injector","","","Select","Select",""],["","","Rosuvastatin Calcium","10 MG","","Select","Select",""],["","","Dexcom G7 Sensor","","","Select","Select",""],["","","Ozempic","","","Select","Select",""],["","","Mometasone Furoate","1 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Misoprostol","0.2 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 7.5-325","","","Select","Select",""],["","","Fenofibrate","48 MG","","Select","Select",""],["","","Clever Choice Comfort Ez Insulin Pen Needles 31Gx8Mm","","","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":""}]}]}