{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael Moore","gend":0,"currentgend":"","add":"2050 Old Clinton Rd Apt I3","city":"Macon","state":"GA","zip":"31211","dob":"1979-10-09","age":"","mstatus":"","insh":"0009064704001","cliId":"","pno":"5612151766","cno":"5612151766","email":"","ename":"","eno":"","pphy":"Cenereitte Canty Jackson","ppno":"4782324590","pcpadd":"654 1ST ST","pcpcity":"MACON","pcpstate":"GA","pcpzip":"31201","pcpcounty":"","pcpid":"","pcpname":"654 1ST ST","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"2050 Old Clinton Rd Apt I3","madd2":"","madd3":"","mcity":"Macon","mstate":"GA","mzip":"31211","pcpfaxno":"","pcpnpi":"1083421242","currentgendcomment":"","pphycomment":"","uniqueid":"508600","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":["L97.522","I70.245","I87.2","Z89.611","Z79.01","I10","E78.49","Z86.711","I73.9","E11.9","Z68.31","Z68.28","I70.202","E11.69","M86.171","E11.51","Z98.62","I70.244","E78.5","I74.3","I70.201","L97.422","M86.9","R26.9"],"date":["2026-07-31","2026-06-23","2026-07-31","2026-07-31","2026-07-31","2026-06-24","2026-06-24","2026-06-24","2026-06-24","2026-06-24","2026-06-24","2026-02-02","2026-06-23","2026-04-27","2026-04-27","2026-05-28","2026-05-28","2026-06-23","2026-03-30","2026-06-23","2026-06-23","2026-05-28","2026-05-28","2026-03-10"],"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":[["","","ATORVASTATIN CALCIUM","40000 MG","","Select","Select",""],["","","AMLODIPINE BESYLATE","10000 MG","","Select","Select",""],["","","CLINDAMYCIN HYDROCHLORIDE","300000 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","0","","Select","Select",""],["","","SILVER SULFADIAZINE","1000 %","","Select","Select",""],["","","ELIQUIS","5000 MG","","Select","Select",""],["","","LISINOPRIL","20000 MG","","Select","Select",""],["","","GABAPENTIN","600000 MG","","Select","Select",""],["","","CLOPIDOGREL","75000 MG","","Select","Select",""],["","","METHYLPREDNISOLONE","32000 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":""}]}]}