{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jeffrey Lee Roper","gend":0,"currentgend":"","add":"591 Maxwell Rd","city":"Blue Ridge","state":"GA","zip":30513,"dob":"1962-10-22","age":"","mstatus":"","insh":"0003801033001","cliId":"","pno":7064556626,"cno":7064556626,"email":"jannaledbetter32@outlook.com","ename":"","eno":"","pphy":"Sarah Cleckler","ppno":7066321155,"pcpadd":"4799 BLUE RIDGE DR STE 104","pcpcity":"BLUE RIDGE","pcpstate":"GA","pcpzip":30513,"pcpcounty":"","pcpid":"","pcpname":"4799 BLUE RIDGE DR STE 104","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"591 Maxwell Rd","madd2":"","madd3":"","mcity":"Blue Ridge","mstate":"GA","mzip":30513,"pcpfaxno":"","pcpnpi":1902238843,"currentgendcomment":"","pphycomment":"","uniqueid":278321,"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":["I21.02","I21.3","I50.21","E87.1","I48.19","N17.9","I25.118","E66.9","D72.829","E87.5","E78.00","E87.6","I95.9","I25.5","N18.30","I25.82","R00.0","R74.01","Z79.02","Z79.82","Z68.32","Z82.49","I10","N18.32","D64.9","E78.2","E03.9","K64.8","R23.9","Z12.5","Z79.899","J06.9","R09.81","R05.1","I25.10","Z00.6","I42.0","I13.0","I50.22","E78.5","I25.2","Z68.28","Z88.8","Z79.01","Z79.84","Z95.5","Z45.02","I48.91","R94.31","I48.0","I50.23","Z01.810","R60.0","R79.89","R06.82","I44.0","Z95.810","Z01.812","L02.413","I42.9","Z68.31","I50.20","R03.0","I51.7","I50.42","J81.1","R00.1","Z46.89","J90","Z95.0","I50.9","Z51.81","Z12.11","Z12.12","I27.20"],"date":["2024-02-21","2023-11-13","2023-07-14","2023-11-13","2026-01-08","2023-07-11","2025-04-01","2023-12-29","2023-07-02","2023-07-02","2023-07-02","2023-07-02","2023-07-04","2026-01-08","2026-01-08","2023-07-02","2023-07-04","2023-07-02","2023-12-29","2023-07-28","2023-07-02","2023-07-02","2025-09-11","2025-09-11","2025-09-11","2025-09-11","2025-09-11","2025-09-11","2025-09-11","2025-09-11","2025-09-11","2024-06-25","2024-06-25","2024-06-25","2026-01-08","2023-12-29","2026-01-08","2023-12-29","2026-01-08","2023-12-29","2024-07-03","2023-12-29","2023-12-29","2023-12-29","2023-12-29","2023-12-29","2026-01-05","2023-07-04","2023-07-28","2023-08-18","2023-07-25","2023-07-24","2023-07-03","2023-07-04","2023-07-04","2026-01-08","2026-01-08","2023-12-20","2023-07-08","2023-07-11","2023-07-11","2023-12-20","2023-08-18","2023-07-28","2025-11-13","2023-07-03","2024-07-03","2023-12-29","2023-12-29","2023-12-29","2023-09-20","2023-11-13","2025-07-28","2025-07-28","2023-11-01"],"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":[["","","Jardiance","10 MG","","Select","Select",""],["","","Clopidogrel","75 MG","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","50 MG","","Select","Select",""],["","","Amiodarone Hydrochloride","400 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Entresto","24 MG","","Select","Select",""],["","","Eliquis","5 MG","","Select","Select",""],["","","Aspirin","81 MG","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Sacubitril\/Valsartan","","","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":""}]}]}