{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter J Gibbons","gend":0,"currentgend":"","add":"107 Jim Lee Dr NE","city":"Rome","state":"GA","zip":30161,"dob":"1972-06-14","age":"","mstatus":"","insh":"0005705775001","cliId":"","pno":4702229487,"cno":4702229487,"email":"peterson7291@gmail.com","ename":"","eno":"","pphy":"Christina Crane","ppno":7062388073,"pcpadd":"501 REDMOND RD NW","pcpcity":"ROME","pcpstate":"GA","pcpzip":30165,"pcpcounty":"","pcpid":"","pcpname":"501 REDMOND RD NW","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"107 Jim Lee Dr NE","madd2":"","madd3":"","mcity":"Rome","mstate":"GA","mzip":30161,"pcpfaxno":7062388081,"pcpnpi":1033206784,"currentgendcomment":"","pphycomment":"","uniqueid":351132,"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":["N39.0","R33.9","Z93.3","K64.1","E11.9","F12.90","Z87.440","Z88.1","F33.1","F43.12","K45.0","D41.4","N31.9","N41.0","N41.1","Z88.2","Z91.040","K62.89","R19.8","Z00.00","K90.822","B00.9","G60.9","E55.9","Z13.220","G89.4","K60.5","N31.8","M54.16","M43.26","M54.2","R10.2","Z79.891","M96.1","Z85.51","N30.00","R10.9","G47.9","Z83.3","G89.29","M54.9","S92.302","R30.0","R15.9","Z87.828","N48.89","Z72.51","M51.36","M54.50","M51.34","K60.0","K59.2","K35.80","K56.1","K63.5","K62.5","R19.4","G58.8","K61.1","M25.512","R10.0","K63.2","D12.3","D12.0","D12.2","M25.511","M54.89","R53.1","K62.1","K64.4","K64.8","F32.1","M47.816","K60.513","Z79.899","K60.2","R21","M51.17","Z98.1","K63.89","K51.90","K94.09","N31.2","G89.18","R10.84","M75.41","M75.42","Z12.11","R33.8","R39.14","K59.09","K52.89","L98.8","R35.0","M48.07","K61.0","K52.9","Q76.1","M79.2","M51.26","G90.59","N30.01","M47.812","K60.30"],"date":["2025-04-19","2025-12-24","2025-12-24","2025-11-07","2025-04-19","2025-04-19","2025-04-19","2025-05-21","2026-02-19","2026-02-19","2025-05-21","2025-01-08","2025-04-22","2025-01-09","2025-01-13","2025-05-21","2025-05-21","2025-04-28","2025-04-28","2026-01-20","2026-01-20","2026-01-20","2026-01-20","2026-01-20","2026-01-20","2026-01-29","2024-06-14","2024-06-14","2026-01-29","2026-01-29","2026-01-29","2025-07-31","2026-01-29","2026-01-29","2025-01-08","2026-01-09","2025-05-21","2024-11-21","2025-01-09","2025-05-21","2025-05-21","2025-05-21","2026-01-09","2025-10-20","2025-05-21","2025-01-15","2024-10-07","2024-08-26","2024-08-26","2024-08-26","2023-09-05","2024-08-20","2025-05-21","2025-05-21","2025-02-20","2025-02-20","2025-02-20","2024-12-09","2025-04-08","2023-06-02","2025-02-06","2024-11-21","2025-02-20","2025-02-20","2025-02-20","2023-06-02","2025-05-21","2025-05-21","2025-09-17","2025-09-17","2025-09-17","2025-02-06","2025-01-15","2025-01-14","2025-01-09","2025-10-28","2025-10-28","2024-12-27","2024-12-27","2025-09-17","2025-09-08","2025-05-21","2025-05-21","2025-05-21","2025-01-08","2023-06-02","2023-06-02","2025-02-20","2025-04-22","2023-02-15","2025-04-02","2025-04-02","2025-04-02","2023-04-04","2024-12-27","2024-05-09","2025-09-17","2024-08-20","2024-08-20","2024-08-20","2024-08-20","2025-01-09","2024-08-26","2025-10-30"],"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":[["","","Trimethoprim","100 MG","","Select","Select",""],["","","Quetiapine","25 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Acetaminophen","325 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Hydrocortisone Acetate","","","Select","Select",""],["","","Amitriptyline Hydrochloride","25 MG","","Select","Select",""],["","","Buprenorphine","0.3 MG","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Valacyclovir","1000 MG","","Select","Select",""],["","","Levofloxacin","500 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Tizanidine","4 MG","","Select","Select",""],["","","Cefuroxime","500 MG","","Select","Select",""],["","","Gabapentin","100 MG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Pregabalin","50 MG","","Select","Select",""],["","","Polyethylene Glycol 3350","240000 MG","","Select","Select",""],["","","Flucelvax 2024-2025","","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","Alprazolam","","","Select","Select",""],["","","Ibuprofen","800 MG","","Select","Select",""],["","","24 Hr Desvenlafaxine Succinate","50 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":""}]}]}