{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Archie Jackson","gend":0,"currentgend":"","add":"707 W Armuchee Rd","city":"La Fayette","state":"GA","zip":"30728","dob":"1964-09-30","age":"","mstatus":"","insh":"0009067717001","cliId":"","pno":"3308275682","cno":"3308275682","email":"pastoraejackson@gmail.com","ename":"","eno":"","pphy":"SOHNA FLORENCE","ppno":"4044227506","pcpadd":"3995 South Cobb Dr","pcpcity":"SMYRNA","pcpstate":"GA","pcpzip":"30080","pcpcounty":"","pcpid":"","pcpname":"3995 South Cobb Dr","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"707 W Armuchee Rd","madd2":"","madd3":"","mcity":"La Fayette","mstate":"GA","mzip":"30728","pcpfaxno":"","pcpnpi":"1134770407","currentgendcomment":"","pphycomment":"","uniqueid":"513280","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":["G56.03","M70.21","I15.2","I25.10","E11.41","E11.59","E78.00","F17.210","Z95.1","Z88.0","Z91.040","R94.31","R82.5","R19.7","R11.2","E11.9","I10","I25.2","F33.2","R45.851","F10.90","F14.90","F41.9","E78.5","K21.9","T43.3X2","Z79.4","Z79.84","Z63.4","Z63.79","Z60.2","G47.00","T50.994","I45.81","S91.109","E11.42","L60.0","B35.3","L30.9","B35.1","L03.032","L84","L85.3","I49.8","Z13.6","L03.031","G56.01","T14.91X","Z78.1","F33.9","G56.23","M65.831"],"date":["2026-01-23","2026-01-23","2026-01-23","2026-07-17","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-07-17","2026-01-23","2026-01-23","2026-07-18","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-20","2026-07-17","2026-07-25","2026-07-20","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-20","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-07-17","2026-08-06","2026-08-06","2026-08-06","2026-08-06","2026-08-06","2026-08-06","2026-01-19","2026-08-06","2026-08-06","2026-07-18","2026-07-18","2026-03-02","2026-01-23","2026-07-17","2026-07-17","2026-07-20","2026-01-23","2026-01-27"],"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":[["","","DOXYCYCLINE HYCLATE","100000 MG","","Select","Select",""],["","","SUCRALFATE","1000 GM","","Select","Select",""],["","","JARDIANCE","10000 MG","","Select","Select",""],["","","AMMONIUM LACTATE","12000 %","","Select","Select",""],["","","CYCLOBENZAPRINE HYDROCHLORIDE","10000 MG","","Select","Select",""],["","","NOVOLOG FLEXPEN","100000 UNIT\/ML","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","40000 MG","","Select","Select",""],["","","GABAPENTIN","600000 MG","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","50 %","","Select","Select",""],["","","MUPIROCIN","2000 %","","Select","Select",""],["","","OXYCODONE HYDROCHLORIDE","5000 MG","","Select","Select",""],["","","VARENICLINE TARTRATE","1000 MG","","Select","Select",""],["","","OXYCODONE\/ACETAMINOPHEN","0","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","150000 MG","","Select","Select",""],["","","LOSARTAN POTASSIUM","50000 MG","","Select","Select",""],["","","TRESIBA FLEXTOUCH","100000 UNIT\/ML","","Select","Select",""],["","","CLOBETASOL PROPIONATE","50 %","","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":""}]}]}