{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David Samoray","gend":0,"currentgend":"","add":"929 Gold Ridge Rd","city":"Dahlonega","state":"GA","zip":30533,"dob":"1967-12-27","age":"","mstatus":"","insh":"0005786989001","cliId":"","pno":7708468777,"cno":7708468777,"email":"jenettesamoray@bellsouth.net","ename":"","eno":"","pphy":"John Nelson","ppno":7702198420,"pcpadd":"108 PROMINENCE CT STE 200","pcpcity":"DAWSONVILLE","pcpstate":"GA","pcpzip":30534,"pcpcounty":"","pcpid":"","pcpname":"108 PROMINENCE CT STE 200","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"929 Gold Ridge Rd","madd2":"","madd3":"","mcity":"Dahlonega","mstate":"GA","mzip":30533,"pcpfaxno":"","pcpnpi":1699120964,"currentgendcomment":"","pphycomment":"","uniqueid":373105,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J84.9","G47.33","J96.11","Z68.39","E66.812","Z23","Z68.41","R30.0","N30.00","E66.01","J84.115","I10","E78.2","R94.39","R63.8","R94.30","Z12.5","Z13.1","Z87.891","Z95.5","Z00.00","Z00.01","I11.9","I25.10","F06.4","G47.9","D84.9","Z68.37","N20.0","R00.0","E78.5","E66.09","Z68.33","Z99.81","Z86.16","R06.2","J40","K42.9","E66.9","R06.09","J02.9","Z20.822","R05.1","R50.9","R09.81","J84.89","J18.9","J47.9","Z68.36","I87.2","R39.89","N17.9","Z13.220","R93.1","F17.200","F17.220","Z79.52","Z68.38","J44.9","U07.1","J12.82","Z12.11","G47.8","J81.1","Z71.3","Z71.82","R06.02","R09.89","R52","R53.83","R53.1","G47.30","R06.83","E66.813","T88.7XX","Z72.0","J98.09","R91.8","R60.0","J96.01"],"date":["2026-01-21","2026-03-20","2026-01-21","2025-06-24","2025-12-02","2025-10-28","2025-02-07","2023-10-18","2023-10-18","2025-12-02","2026-02-27","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2023-05-01","2025-07-31","2025-07-31","2025-12-02","2025-12-02","2026-02-12","2025-12-02","2025-12-02","2025-12-02","2025-12-02","2026-02-12","2025-01-09","2025-08-05","2024-08-27","2024-08-27","2024-08-27","2025-05-01","2024-08-27","2023-12-27","2023-12-26","2026-01-21","2026-01-21","2026-01-21","2024-05-10","2023-12-18","2024-05-10","2024-05-10","2023-01-27","2023-09-21","2023-09-21","2025-02-20","2026-01-21","2024-12-27","2023-05-01","2025-10-28","2023-10-27","2024-07-08","2024-02-19","2024-03-08","2024-03-08","2025-08-18","2025-08-18","2023-10-04","2023-10-04","2023-05-10","2023-05-04","2023-09-20","2023-12-07","2023-12-07","2026-01-21","2024-05-10","2024-05-10","2023-12-18","2024-05-10","2023-03-17","2023-03-17","2025-05-01","2024-03-07","2023-10-02","2023-12-27","2023-12-18","2025-08-05","2024-03-20"],"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":[["","","Prednisone","1 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Sertraline","25 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Aspirin","81 MG","","Select","Select",""],["","","Topiramate","25 MG","","Select","Select",""],["","","Pitavastatin","4 MG","","Select","Select",""],["","","Benzonatate","100 MG","","Select","Select",""],["","","Metoprolol Tartrate","25 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Brilinta","90 MG","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Pitavastatin Calcium","","","Select","Select",""],["","","1 Ml Evolocumab","140 MG","","Select","Select",""],["","","Repatha Sureclick","","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Tamsulosin Hydrochloride","0.4 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Rosuvastatin Calcium","10 MG","","Select","Select",""],["","","{11 Varenicline","0.5 MG","","Select","Select",""],["","","Clopidogrel","75 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":""}]}]}