{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul Albert Shires","gend":0,"currentgend":"","add":"4974 Planters Way","city":"Flowery Branch","state":"GA","zip":30542,"dob":"1962-02-16","age":"","mstatus":"","insh":"0004738096001","cliId":"","pno":7709124857,"cno":6788288376,"email":"pshir2@gmail.com","ename":"","eno":"","pphy":"Robert Kelly","ppno":7705031481,"pcpadd":"1515 RIVER PL STE 100","pcpcity":"BRASELTON","pcpstate":"GA","pcpzip":30517,"pcpcounty":"","pcpid":"","pcpname":"1515 RIVER PL STE 100","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"4974 Planters Way","madd2":"","madd3":"","mcity":"Flowery Branch","mstate":"GA","mzip":30542,"pcpfaxno":7705031520,"pcpnpi":1386619526,"currentgendcomment":"","pphycomment":"","uniqueid":316750,"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":["E11.9","E78.01","I10","Z68.27","K81.0","I96","K74.60","K76.0","J02.9","K40.90","Z79.84","Z79.82","Z79.899","E11.40","E78.5","G47.33","I26.99","I21.9","K75.81","K74.00","D22.5","L81.4","L82.1","L57.8","D48.5","L57.0","R07.89","Z00.00","D69.6","E11.21","R29.6","E78.49","J30.89","Z68.28","R23.8","Z68.29","R05.1","Z20.822","J20.8","I45.10","R07.9","Z12.5","Z13.0","Z13.29","R10.32","R07.0","R09.81","R11.0","K40.91","Z90.49","K75.89","L03.314","K82.8","M79.89","K74.02","Z13.220","K63.5","K57.30","K64.0","E78.00","L03.115","U07.1","L03.116","H25.13","H52.4","R16.1","R18.8","K29.60","N52.9","Z12.11","Z86.010","D12.2","K42.9","Z00.01","I11.9","E78.019","G25.0","B35.6","Z68.30","R06.83","K29.50","R40.4","I27.20","R63.8"],"date":["2025-06-13","2025-06-16","2025-06-23","2023-05-22","2023-03-17","2023-03-13","2024-05-28","2024-05-14","2023-03-13","2025-09-16","2023-03-13","2023-03-13","2025-06-13","2025-12-17","2025-06-13","2025-06-13","2025-06-13","2025-06-13","2024-01-24","2025-12-17","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2025-06-20","2024-05-28","2024-05-28","2025-06-16","2024-06-25","2024-05-28","2024-05-28","2024-05-28","2025-06-17","2026-03-12","2025-03-23","2025-03-23","2025-03-23","2025-06-23","2025-06-13","2024-05-14","2024-05-14","2024-05-14","2025-06-23","2023-03-13","2023-03-13","2023-03-13","2025-09-16","2023-04-11","2023-03-15","2025-01-03","2023-03-14","2025-06-20","2024-05-14","2025-12-10","2024-06-06","2025-06-23","2024-06-06","2023-03-15","2026-03-12","2025-01-05","2025-01-05","2025-04-14","2025-04-14","2023-03-14","2023-03-14","2024-01-24","2023-03-29","2024-06-06","2024-06-06","2024-06-06","2025-09-16","2025-12-17","2025-12-17","2025-12-17","2025-12-17","2025-12-17","2025-12-17","2023-01-05","2024-01-24","2023-01-19","2025-06-16","2025-06-16"],"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":[["","","Ezetimibe","10 MG","","Select","Select",""],["","","Pioglitazone","45 MG","","Select","Select",""],["","","Ozempic","2 MG","","Select","Select",""],["","","Hydrochlorothiazide","25 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Metformin Hydrochloride","1000 MG","","Select","Select",""],["","","Oxycodone Hydrochloride","5 MG","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","Simvastatin","20 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","0.5 Ml Influenza A Virus A\/Darwin\/11\/2021 H3N2 Antigen","0.03 MG","","Select","Select",""],["","","Magnesium Sulfate","0.0277 MEQ","","Select","Select",""],["","","Contour Test Strip","","","Select","Select",""],["","","Mounjaro","5 MG","","Select","Select",""],["","","Hydrocodone\/Acetaminophen","","","Select","Select",""],["","","Flublok 2025-2026","","","Select","Select",""],["","","0.5 Ml Varicella Zoster Virus Glycoprotein E, Recombinant","0.1 MG","","Select","Select",""],["","","Clotrimazole\/Betamethasone Dipropionate","","","Select","Select",""],["","","Amox-Clav 875-125 Mg Tablet","","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Flucelvax Trival 2024-2025 Syr","","","Select","Select",""],["","","Prevnar 20 Syringe","","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Cephalexin","","","Select","Select",""],["","","Mupirocin","0.02 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Contour Next Blood Glucose Test","","","Select","Select",""],["","","Chlorhexidine Gluconate","","","Select","Select",""],["","","Amoxicillin","875 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":""}]}]}