{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"April Potts","gend":1,"currentgend":"","add":"5 Rita K Dr NW","city":"Rome","state":"GA","zip":30165,"dob":"1962-10-26","age":"","mstatus":"","insh":"0000622877001","cliId":"","pno":7062320714,"cno":7062321076,"email":"mpotts56@comcast.net","ename":"","eno":"","pphy":"Amine Bourbia","ppno":7622352150,"pcpadd":"1825 MARTHA BERRY BLVD NW","pcpcity":"ROME","pcpstate":"GA","pcpzip":30165,"pcpcounty":"","pcpid":"","pcpname":"1825 MARTHA BERRY BLVD NW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"5 Rita K Dr NW","madd2":"","madd3":"","mcity":"Rome","mstate":"GA","mzip":30165,"pcpfaxno":7062918380,"pcpnpi":1295141927,"currentgendcomment":"","pphycomment":"","uniqueid":190105,"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":["J45.50","I67.1","R05.3","H69.81","H93.11","J30.89","H90.3","J34.89","J33.0","E87.1","E87.21","E11.65","G35","I10","E03.9","J45.909","F32.A","E66.9","K50.90","N17.9","E11.42","Z93.2","K21.9","E78.5","F41.9","E86.0","M19.079","Z88.5","Z88.6","Z88.8","Z79.1","Z79.51","Z79.899","M54.59","N39.0","I47.20","R00.2","I25.10","Z00.00","E78.2","E03.4","F41.1","J45.991","E66.812","G35.D","Z87.440","Z68.36","H91.91","E11.9","R44.8","R51.9","J01.90","H69.83","E87.5","Z01.419","Z68.34","N95.2","R10.2","F41.8","M19.072","M19.071","M62.830","E55.9","J45.30","R39.14","M53.3","Z12.31","J30.9","B99.9","Z91.038","J32.9","R76.8","K50.118","H66.001","R68.84","H92.11","Z00.01","M51.37","G40.802","G47.33","R11.2","H90.71","H92.01","H65.01","G35.A","R41.89","G89.4","N95.1","E11.69","J02.9","H65.191","H90.8","R07.89","M81.0","R13.19","R19.7","M48.061","J40","M51.16","Z68.35","Z71.3","Z71.89","L82.0","L82.1","D18.01","L30.4","R92.323","R30.0","R00.0","M43.16","M47.26","J04.0","N90.89","R07.2","H90.42","D32.0","B37.31","R07.9","N30.90","N94.9","N83.209","M16.0","M54.16","M47.896","M99.03","M46.06","N17.8","E83.42","R53.83","N32.81","R35.0","R39.15","J33.9","H53.8","I47.10","D32.9","N76.0","K50.00","F33.1","I66.01","H93.A1","R09.82","R06.09","R39.2","L08.9","E11.40","M85.88","S00.83X","J01.00","R07.81","Z12.39"],"date":["2026-03-05","2026-02-23","2025-04-18","2025-10-08","2025-07-21","2026-02-23","2026-02-23","2025-07-21","2025-07-21","2025-03-12","2025-03-10","2025-03-12","2025-04-16","2025-11-03","2025-03-12","2025-03-12","2025-10-08","2025-03-10","2025-03-10","2025-03-12","2025-03-10","2025-03-19","2026-03-11","2025-03-12","2025-03-12","2025-03-10","2025-03-10","2025-03-10","2025-03-10","2025-03-10","2025-03-10","2025-03-10","2025-07-11","2024-08-01","2026-03-05","2025-01-29","2025-04-21","2025-01-29","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2025-03-20","2026-02-02","2024-04-22","2024-12-09","2026-02-23","2026-02-23","2026-02-02","2025-08-13","2023-10-16","2023-07-31","2023-08-11","2025-07-11","2025-01-13","2025-01-13","2024-09-04","2025-04-15","2024-09-04","2024-01-23","2024-04-17","2025-08-19","2026-01-08","2025-09-11","2026-01-08","2025-08-07","2025-08-07","2026-03-11","2026-01-09","2025-09-22","2026-01-09","2025-04-15","2024-05-22","2025-04-15","2025-04-18","2025-03-10","2025-04-21","2025-02-24","2024-12-16","2025-10-08","2025-10-08","2025-10-08","2025-06-16","2025-11-03","2024-12-09","2024-12-09","2024-12-09","2024-01-10","2025-04-15","2026-03-11","2025-06-20","2025-08-20","2025-07-16","2025-08-20","2025-07-16","2025-07-16","2025-07-16","2025-11-19","2025-04-14","2025-04-14","2025-09-04","2025-08-19","2026-03-05","2023-10-16","2025-08-20","2025-08-20","2026-02-23","2025-06-16","2023-10-18","2025-03-24","2025-03-24","2025-01-13","2023-10-18","2026-02-23","2023-08-18","2023-08-18","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2025-03-19","2025-03-19","2025-03-19","2026-03-05","2025-11-12","2025-11-12","2024-12-30","2024-04-23","2026-02-06","2025-04-16","2025-11-03","2025-07-07","2025-01-13","2025-04-16","2025-02-24","2025-09-26","2023-09-12","2025-03-10","2025-03-10","2025-03-12","2024-08-15","2023-04-12","2023-04-12","2024-08-29","2024-08-15"],"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":[["","","Gabapentin","100 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Rosuvastatin Calcium","10 MG","","Select","Select",""],["","","Celecoxib","100 MG","","Select","Select",""],["","","Dimethyl Fumarate","240 MG","","Select","Select",""],["","","Cefuroxime","500 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Escitalopram","20 MG","","Select","Select",""],["","","Oxcarbazepine","300 MG","","Select","Select",""],["","","Fenofibric Acid","135 MG","","Select","Select",""],["","","Olmesartan Medoxomil","5 MG","","Select","Select",""],["","","Breo Ellipta 200-25 Mcg Inh","","","Select","Select",""],["","","Nda020503 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Alprazolam","1 MG","","Select","Select",""],["","","0.5 Ml Influenza A Virus A\/Darwin\/11\/2021 H3N2 Antigen","0.03 MG","","Select","Select",""],["","","Prevnar 20 Syringe","","","Select","Select",""],["","","Breztri Aerosphere Inhaler","","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","100 MG","","Select","Select",""],["","","Metoprolol Tartrate","25 MG","","Select","Select",""],["","","Chlorzoxazone","500 MG","","Select","Select",""],["","","Tobramycin","3 MG","","Select","Select",""],["","","Synthroid","175 MCG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Ofloxacin","3 MG","","Select","Select",""],["","","Sumatriptan","50 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Breztri Aerosphere","","","Select","Select",""],["","","Azelastine Hydrochloride","0.137 MG","","Select","Select",""],["","","Dexamethasone Phosphate","1 MG","","Select","Select",""],["","","Ipratropium Bromide","0.042 MG","","Select","Select",""],["","","Hydrochlorothiazide","25 MG","","Select","Select",""],["","","Pregabalin","100 MG","","Select","Select",""],["","","Levetiracetam","500 MG","","Select","Select",""],["","","Fluzone Trivalent 2024-25 Syrg","","","Select","Select",""],["","","Prednisolone Acetate","10 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Promethazine Hydrochloride","25 MG","","Select","Select",""],["","","Capvaxive","","","Select","Select",""],["","","Doxycycline Hyclate","","","Select","Select",""],["","","Albuterol","0.83 MG","","Select","Select",""],["","","Fluarix 2025-2026","","","Select","Select",""],["","","Estradiol","0.1 MG","","Select","Select",""],["","","Levofloxacin","500 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":""}]}]}