{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roberto Burgos Caez","gend":0,"currentgend":"","add":"4719 Victoria Dr","city":"Flowery Branch","state":"GA","zip":"30542","dob":"1966-05-25","age":"","mstatus":"","insh":"0009083672001","cliId":"","pno":"7872718716","cno":"7872718716","email":"knightcat1966@gmail.com","ename":"","eno":"","pphy":"Ugochukwu Egolum","ppno":"7705342020","pcpadd":"743 SPRING ST NE","pcpcity":"GAINESVILLE","pcpstate":"GA","pcpzip":"305013715","pcpcounty":"","pcpid":"","pcpname":"743 SPRING ST NE","plan":"Alliant","program":"ACA","lob":"","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"4719 Victoria Dr","madd2":"","madd3":"","mcity":"Flowery Branch","mstate":"GA","mzip":"30542","pcpfaxno":"","pcpnpi":"1558687384","currentgendcomment":"","pphycomment":"","uniqueid":"533182","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["Spanish"]],"comment":[[]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.43","J96.01","R57.0","E87.20","I50.84","D63.1","Z79.01","Z79.02","I13.0","I27.20","N18.31","I34.81","I48.91","I25.5","I25.2","I25.10","E78.2","D50.9","Z79.899","Z79.82","Z95.5","Z86.73","Z87.891","Z95.811","I50.9","Z01.810","R00.1","I45.81","N18.30","I50.82","I69.328","I50.810","J81.0","Z45.09","Z51.5","K66.1","G93.40","I82.612","I82.A12","I82.C12","I82.B12","D62","Z68.1","J98.11","E87.1","I48.0","I34.0","I51.7","I51.89","Z45.2","R06.02","Z12.5","E53.8","E55.9","Z13.29","I25.3","I69.30","I50.42","Z86.718","T50.2X6","Z91.128","E78.5","I25.82","R09.1","I50.23","I50.22","Z68.20","T82.9XX","Z01.818","Z91.89","I97.190","I49.9","I07.1","I31.39","E78.49","I51.9","Z00.00","D63.8","N18.9","D64.9","D72.828","R07.9","I51.4","J90","Z13.1","I08.0","D72.829","Z09","K59.09","K04.6","I45.4","I21.4","K59.00","E87.29","E11.22","I95.9","R94.2","R91.8","I50.21","I35.8","T81.10X","J98.4","R06.89","I50.41","I82.622","M79.89"],"date":["2026-07-06","2026-05-04","2026-05-04","2026-03-13","2026-06-15","2026-07-28","2026-06-12","2026-06-12","2026-07-28","2026-05-04","2026-07-28","2026-06-12","2026-07-28","2026-07-06","2026-06-12","2026-08-19","2026-07-28","2026-04-16","2026-06-12","2026-06-12","2026-04-13","2026-07-21","2026-03-13","2026-07-21","2026-04-07","2026-03-11","2026-04-03","2026-04-03","2026-07-06","2026-07-28","2026-07-06","2026-05-03","2026-03-10","2026-06-14","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-05-04","2026-06-12","2026-05-12","2026-05-04","2026-06-12","2026-07-21","2026-04-04","2026-04-07","2026-04-15","2026-03-11","2026-03-10","2026-07-23","2026-07-23","2026-07-23","2026-07-23","2026-06-12","2026-06-12","2026-07-28","2026-07-21","2026-06-12","2026-06-12","2026-06-15","2026-06-12","2026-06-12","2026-06-26","2026-08-19","2026-06-19","2026-06-15","2026-03-26","2026-03-29","2026-04-14","2026-04-15","2026-04-15","2026-04-16","2026-06-12","2026-06-25","2026-07-21","2026-07-21","2026-04-15","2026-04-22","2026-03-31","2026-06-12","2026-04-07","2026-04-16","2026-07-23","2026-03-09","2026-04-08","2026-06-19","2026-03-19","2026-03-11","2026-04-17","2026-03-13","2026-08-19","2026-03-09","2026-07-28","2026-04-15","2026-04-08","2026-04-09","2026-03-09","2026-04-16","2026-04-07","2026-03-11","2026-04-07","2026-03-10","2026-06-12","2026-04-17"],"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":[["","","CARVEDILOL","25000 MG","","Select","Select",""],["","","SPIRONOLACTONE","25000 MG","","Select","Select",""],["","","EZETIMIBE","10000 MG","","Select","Select",""],["","","AMIODARONE HYDROCHLORIDE","200000 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","40000 MG","","Select","Select",""],["","","CLOPIDOGREL","75000 MG","","Select","Select",""],["","","SACUBITRIL\/VALSARTAN","0","","Select","Select",""],["","","LOSARTAN POTASSIUM","25000 MG","","Select","Select",""],["","","TORSEMIDE","20000 MG","","Select","Select",""],["","","MUPIROCIN","2000 %","","Select","Select",""],["","","JARDIANCE","10000 MG","","Select","Select",""],["","","ASPIRIN","81000 MG","","Select","Select",""],["","","NITROGLYCERIN","400 MG","","Select","Select",""],["","","ELIQUIS","5000 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":""}]}]}