{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jessica Pollock","gend":1,"currentgend":"","add":"763 Cook Rd","city":"Moultrie","state":"GA","zip":31788,"dob":"1988-03-30","age":"","mstatus":"","insh":"0004921607002","cliId":"","pno":2294540409,"cno":2294540409,"email":"","ename":"","eno":"","pphy":"Jermaine Robinson","ppno":2299853420,"pcpadd":"3131 S MAIN ST","pcpcity":"MOULTRIE","pcpstate":"GA","pcpzip":31768,"pcpcounty":"","pcpid":"","pcpname":"3131 S MAIN ST","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"763 Cook Rd","madd2":"","madd3":"","mcity":"Moultrie","mstate":"GA","mzip":31788,"pcpfaxno":"","pcpnpi":1518520915,"currentgendcomment":"","pphycomment":"","uniqueid":351316,"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":["Z12.4","K92.0","D64.89","M25.511","S13.9XX","T14.8XX","F17.200","Z68.21","I85.00","K92.2","F10.10","D64.9","I85.11","D62","K76.6","K31.89","F10.11","F12.10","M54.16","S62.327","K74.60","I85.10","Z87.19","M25.512","M53.82","I81","R74.01","I10","F17.210","Z88.6","Z53.29","S43.102","M79.642","R18.8","K70.31","M54.12","D18.09","Z79.899","R79.1","N87.9","S22.019","S22.039","S22.029","J02.0","R05.9","J02.9","H92.09","R50.9","Z71.3","Z71.82","Z30.09","Z13.31","M47.816","M51.36","M54.59","G89.29","R10.12","K70.30","M79.18","M35.7","Z68.20","R10.2","R87.610","R87.810","Z32.02","Z68.1","R00.0","I86.4","K22.89","N83.201","Y90.0","M54.2","E22.1","M54.89","R68.89","S32.10X","K76.89","R10.9","K83.8","K80.20","F17.219","D06.7","E87.6","D50.0","I85.01","G56.02","M54.9","S22.009","R07.9","S43.005","S12.691","S22.018","S22.028","S12.601","W01.198","Y92.009","Y99.8","Y93.89","M75.52"],"date":["2023-07-06","2024-01-04","2024-01-04","2025-05-14","2025-05-14","2025-05-14","2025-08-26","2025-07-22","2024-01-02","2024-01-04","2024-01-04","2024-05-23","2024-01-02","2024-01-04","2024-01-02","2023-09-11","2023-04-28","2023-04-25","2023-04-27","2025-07-02","2024-01-04","2023-09-11","2024-01-17","2024-09-04","2024-01-25","2024-01-02","2024-01-02","2024-01-02","2024-01-02","2024-01-02","2024-01-02","2024-09-04","2025-04-09","2024-01-04","2024-01-04","2025-08-26","2025-07-22","2024-05-23","2024-05-23","2024-03-11","2023-12-08","2023-12-08","2023-12-08","2026-01-26","2026-01-26","2026-01-26","2026-01-26","2026-01-26","2026-01-26","2026-01-26","2026-01-26","2026-01-26","2023-04-28","2023-04-19","2023-04-19","2023-04-19","2024-01-01","2023-09-29","2024-09-04","2024-09-04","2024-09-04","2023-08-03","2023-11-16","2023-11-16","2023-11-16","2024-08-12","2023-04-25","2024-01-02","2023-09-11","2023-08-03","2024-01-01","2025-05-14","2023-08-28","2023-01-23","2023-02-14","2023-01-23","2023-09-29","2023-04-27","2023-10-09","2024-01-02","2023-09-11","2023-11-16","2024-01-04","2024-01-01","2024-01-02","2025-07-02","2024-01-12","2024-01-12","2024-01-02","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2024-02-05"],"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":[["","","Folic Acid","1 MG","","Select","Select",""],["","","Diazepam","2 MG","","Select","Select",""],["","","Spironolactone","100 MG","","Select","Select",""],["","","Hydroxyzine Hydrochloride","25 MG","","Select","Select",""],["","","Lactulose","10 GM","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Gabapentin","100 MG","","Select","Select",""],["","","Furosemide","40 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Fluticasone Propionate","0.05 MG","","Select","Select",""],["","","{6 Azithromycin","250 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":""}]}]}