{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul Thomas Sampson","gend":0,"currentgend":"","add":"12300 Highway 225 N","city":"Crandall","state":"GA","zip":30711,"dob":"1972-09-16","age":"","mstatus":"","insh":"0009033524001","cliId":"","pno":7069800218,"cno":7065293601,"email":"tsampson55@gmail.com","ename":"","eno":"","pphy":"Jason Cox","ppno":8659090090,"pcpadd":"975 E 3RD ST","pcpcity":"CHATTANOOGA","pcpstate":"TN","pcpzip":374032147,"pcpcounty":"","pcpid":"","pcpname":"975 E 3RD ST","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"12300 Highway 225 N","madd2":"","madd3":"","mcity":"Crandall","mstate":"GA","mzip":30711,"pcpfaxno":8659099883,"pcpnpi":1720016710,"currentgendcomment":"","pphycomment":"","uniqueid":234812,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C43.9","R30.0","F41.0","E11.65","I10","Z95.2","F41.9","F32.A","C79.31","C43.59","C43.8","C79.51","M84.58X","N17.9","E83.39","D84.9","F11.20","D50.8","I12.9","Z79.4","E11.22","E78.5","R79.1","G89.3","Z88.5","Z79.69","Z79.899","Z79.01","D63.0","R31.9","N18.2","J18.9","C78.00","C77.3","N18.32","D50.9","I82.403","G89.29","R51.9","H53.8","Z85.820","J18.1","D64.9","C77.9","D43.2","N18.9","R40.243","Z86.718","F51.01","R79.89","G93.41","G93.6","J69.0","G93.5","C49.9","C78.7","K21.9","Z85.89","A41.9","I45.10","C79.9","E11.9","R94.31","R41.82","G93.9","Z46.82","Z95.4","G93.89","C80.1","R61","G93.40","R41.89","E78.49"],"date":["2026-02-25","2025-09-22","2025-09-22","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2025-09-22","2026-03-13","2026-03-13","2026-03-13","2025-07-16","2025-07-16","2025-07-16","2025-07-16","2025-07-16","2025-07-16","2025-10-22","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2025-07-16","2026-02-25","2025-07-16","2025-07-16","2026-02-13","2026-02-13","2025-07-16","2025-07-16","2025-07-16","2026-02-13","2026-02-13","2025-12-03","2025-10-08","2025-10-08","2025-10-08","2026-02-13","2025-07-16","2025-07-16","2026-02-14","2026-02-13","2025-10-29","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2025-10-20","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2026-02-23","2026-02-13","2026-02-13","2026-02-12","2026-02-12","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2026-02-13","2026-02-14","2025-10-21","2026-02-12","2026-02-13","2026-02-13","2026-02-13"],"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":[["","","Ondansetron","8 MG","","Select","Select",""],["","","Oxycodone Hydrochloride","30 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Warfarin Sodium","7.5 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","{3 Azithromycin","500 MG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Clever Choice Comfort Ez Pen Needles 32Gx4Mm","","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Nystatin 100 Unt\/Mg Topical Powder","","","Select","Select",""],["","","Dexcom G7 Sensor","","","Select","Select",""],["","","Alprazolam","0.5 MG","","Select","Select",""],["","","Dronabinol","2.5 MG","","Select","Select",""],["","","Sertraline Hydrochloride","","","Select","Select",""],["","","Novolog Flexpen","","","Select","Select",""],["","","Dexamethasone","4 MG","","Select","Select",""],["","","72 Hr Fentanyl","0.1 MG","","Select","Select",""],["","","Nystop","","","Select","Select",""],["","","Fentanyl","","","Select","Select",""],["","","Nystatin","","","Select","Select",""],["","","Prochlorperazine","10 MG","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","3 Ml Insulin Glargine-Yfgn 100 Unt\/Ml Pen Injector [Semglee]","","","Select","Select",""],["","","3 Ml Insulin Glargine-Yfgn 100 Unt\/Ml Pen Injector","","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Levetiracetam","500 MG","","Select","Select",""],["","","Diazepam","","","Select","Select",""],["","","Lorazepam","","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 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":""}]}]}