{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James Robert Childs","gend":0,"currentgend":"","add":"2847 Glen Echo Dr","city":"Lizella","state":"GA","zip":"31052","dob":"1971-09-08","age":"","mstatus":"","insh":"0009048072001","cliId":"","pno":"4783616196","cno":"","email":"","ename":"","eno":"","pphy":"Daryl Remick","ppno":"4784050045","pcpadd":"3448 VINEVILLE AVE","pcpcity":"MACON","pcpstate":"GA","pcpzip":"31204","pcpcounty":"","pcpid":"","pcpname":"3448 VINEVILLE AVE","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"2847 Glen Echo Dr","madd2":"","madd3":"","mcity":"Lizella","mstate":"GA","mzip":"31052","pcpfaxno":"4784050054","pcpnpi":"1174956478","currentgendcomment":"","pphycomment":"","uniqueid":"484191","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":["F17.210","I70.211","Z79.84","Z79.4","E11.22","E78.2","E29.1","E03.9","Z79.891","F11.11","Z01.00","Z71.6","I70.221","I70.202","E11.9","F17.200","I73.9","R93.1","Z00.00","Z53.20","Z12.12","Z91.81","Z79.899","Z72.0","Z87.891","Z51.81","L03.811","N18.1","I70.213","M79.604","R68.89"],"date":["2026-05-08","2026-05-08","2026-05-08","2026-05-08","2026-07-20","2026-08-19","2026-07-20","2026-08-19","2026-07-20","2026-08-19","2026-07-20","2026-03-18","2026-05-08","2026-05-08","2026-05-27","2026-05-08","2026-04-21","2026-05-27","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-04-07","2026-03-10","2026-01-27","2026-04-07","2026-04-09","2026-04-28","2026-03-10","2026-03-10","2026-03-02"],"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":[["","","JARDIANCE","25000 MG","","Select","Select",""],["","","ASPIRIN LOW DOSE","81000 MG","","Select","Select",""],["","","INSULIN GLARGINE-YFGN","100000 UNIT\/ML","","Select","Select",""],["","","VARENICLINE TARTRATE","1000 MG","","Select","Select",""],["","","CLOPIDOGREL","75000 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40000 MG","","Select","Select",""],["","","BUPRENORPHINE HYDROCHLORIDE\/NALOXONE HYDROCHLORIDE","0","","Select","Select",""],["","","TESTOSTERONE","1620 %","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","175000 MCG","","Select","Select",""],["","","VARENICLINE STARTING MONTH","0","","Select","Select",""],["","","MUPIROCIN","2000 %","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","0","","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":""}]}]}