{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas D Hammond","gend":0,"currentgend":"","add":"1664 Prospect Rd","city":"Aragon","state":"GA","zip":30104,"dob":"1962-10-01","age":"","mstatus":"","insh":"0004090807004","cliId":"","pno":7705460071,"cno":"","email":"ritaleehammond@yahoo.com","ename":"","eno":"","pphy":"Jolie Puckett","ppno":7065095000,"pcpadd":"304 TURNER MCCALL BLVD SW","pcpcity":"ROME","pcpstate":"GA","pcpzip":301655621,"pcpcounty":"","pcpid":"","pcpname":"304 TURNER MCCALL BLVD SW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"1664 Prospect Rd","madd2":"","madd3":"","mcity":"Aragon","mstate":"GA","mzip":30104,"pcpfaxno":"","pcpnpi":1386473403,"currentgendcomment":"","pphycomment":"","uniqueid":259665,"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":["J44.1","R05.1","H54.8","I10","Z87.891","I45.10","I44.4","R94.31","E11.51","Z79.02","J44.9","J45.50","G89.4","F10.90","E78.2","Z79.82","Z91.199","H35.60","I65.23","J22","J44.0","N43.3","N43.40","M79.89","R07.9","R94.39","E11.9","D12.2","D12.3","D12.5","E78.00","J44.89","I70.208","I11.9","Z79.899","Z90.49","R79.89","H35.62","I16.0","I11.0","I50.9","Z53.29","I77.1","Z12.11","Z86.010","K63.5","K57.30","R06.02","Z79.1","Z87.19","Z20.822","Z88.0","Z88.1","R09.81","R03.0","I70.8","J18.9","K62.89","I21.4","H33.001","H40.119","F17.211","Z68.31","H57.11","Z09","F17.201","Z68.32","I49.8","L03.115","S90.31X","Z79.891","R00.0","I25.118","N50.89","N43.41","M47.896","M48.061","M47.816","M79.671","M79.672","I65.21","R29.90","Z72.0","H57.12","U07.1","G62.89","I87.2","R50.9","J45.901","R07.2","R07.89","R01.0","I34.0","Z01.818","H54.61","R42","I65.29","J96.20"],"date":["2025-11-26","2025-08-16","2026-02-02","2026-02-19","2026-01-28","2026-02-04","2026-02-04","2026-02-04","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2026-02-04","2026-02-02","2026-02-02","2026-02-02","2025-04-28","2026-03-19","2025-07-17","2025-07-17","2024-04-25","2024-04-25","2024-04-25","2026-02-04","2026-02-04","2026-02-19","2024-12-20","2024-12-20","2024-12-20","2026-01-28","2026-01-28","2026-01-28","2026-01-28","2026-02-01","2026-01-28","2026-02-02","2025-04-26","2025-04-26","2024-08-09","2024-08-09","2024-08-09","2026-01-28","2024-12-20","2024-12-20","2024-12-20","2024-12-20","2024-03-22","2024-03-22","2024-03-22","2024-03-22","2024-03-22","2024-03-22","2024-01-15","2026-02-02","2026-01-22","2025-12-15","2024-12-20","2026-02-04","2025-04-26","2025-04-26","2026-01-27","2025-12-15","2025-04-26","2026-02-19","2025-09-26","2025-01-27","2026-02-02","2024-02-18","2024-02-18","2025-10-24","2025-04-26","2026-02-04","2024-04-25","2024-04-25","2026-01-16","2026-01-16","2026-01-16","2026-01-16","2026-01-16","2026-03-19","2025-04-27","2026-02-04","2025-04-26","2024-08-09","2026-01-16","2026-01-28","2025-08-16","2025-09-26","2026-02-03","2026-02-02","2025-04-28","2025-04-28","2026-01-27","2026-01-27","2025-04-26","2025-12-30","2024-08-09"],"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":[["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Trelegy Ellipta","","","Select","Select",""],["","","Prednisolone Acetate","10 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Nucala","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Clopidogrel","75 MG","","Select","Select",""],["","","Metoprolol Tartrate","","","Select","Select",""],["","","Hydrocodone-Acetamin 10-325 Mg","","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Trelegy Ellipta 200-62.5-25","","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Levofloxacin","750 MG","","Select","Select",""],["","","Accu-Chek Softclix Lancets","","","Select","Select",""],["","","Rosuvastatin Calcium","10 MG","","Select","Select",""],["","","Lidocaine-Prilocaine Cream","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Polyethylene Glycol 3350","236000 MG","","Select","Select",""],["","","Hydrochlorothiazide","25 MG","","Select","Select",""],["","","Albuterol Sulfate","","","Select","Select",""],["","","Amoxicillin\/Clavulanate Potassium","","","Select","Select",""],["","","Ventolin Hfa","","","Select","Select",""],["","","Eq Aspirin Low Dose","","","Select","Select",""],["","","Folic Acid","1 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Dextromethorphan Hydrobromide","3 MG","","Select","Select",""],["","","Albuterol Sul","2.5 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Aspirin Low Dose","","","Select","Select",""],["","","{21 Methylprednisolone","4 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":""}]}]}