{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth Hambrick House","gend":1,"currentgend":"","add":"373 Buckeye Ln S","city":"Dahlonega","state":"GA","zip":30533,"dob":"1963-11-24","age":"","mstatus":"","insh":"0003818252001","cliId":"","pno":7703789142,"cno":7703789142,"email":"bethhhouse@gmail.com","ename":"","eno":"","pphy":"Kelly Mackey","ppno":7702199260,"pcpadd":"73 MAXWELL LN","pcpcity":"DAHLONEGA","pcpstate":"GA","pcpzip":30533,"pcpcounty":"","pcpid":"","pcpname":"73 MAXWELL LN","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"373 Buckeye Ln S","madd2":"","madd3":"","mcity":"Dahlonega","mstate":"GA","mzip":30533,"pcpfaxno":"","pcpnpi":1225101371,"currentgendcomment":"","pphycomment":"","uniqueid":335100,"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":["C79.51","J91.0","Z79.01","D68.51","E78.2","Z86.711","Z88.5","Z79.69","Z51.12","C34.11","J41.1","Z68.30","J90","I36.1","I31.39","R10.9","R05.1","J22","Z68.31","R39.15","R10.811","M54.50","M89.9","K44.9","K42.9","Z00.01","Z23","F32.A","N64.4","E66.811","R00.2","R06.2","R09.81","Z85.118","I34.1","Z79.899","Z98.890","Z96.89","I48.92","Z51.81","Z78.0","E66.8","R06.09","R05.9","R53.83","R11.0","R05.2","R06.02","J40","J18.9","K76.0","D51.3","Z48.813","H25.031","H04.123","H16.223","G43.B1","H52.11","H52.222","H52.4","D31.32","H25.041","H25.13","N30.00","Z13.0","Z13.29","S93.402","Z13.31","F41.1","Z68.32","H25.12","H35.89","Z00.00","N39.0","C38.0","Z79.890","R09.02","J10.1","Z20.822","J01.00","R68.89","J06.9","H25.11","R39.9","J96.02","Z12.4","R50.9","R05.8","A41.9","D72.819","R30.0","R35.0","S82.52X","Z68.29","R10.11","M79.89","R91.8","H69.92","E66.09","J01.40","Z68.28","J96.01","C38.4","R92.0","D22.62","D22.71","D22.5","L57.3","L82.1","B36.0","L60.3","Z71.89","Z92.3","S93.492","F41.9","F06.31","M25.572","S99.912","J18.1","I49.9","M25.541","Z45.2","Z12.11","Z12.12","F06.30","Z63.79","Z71.1","H25.011","H25.012","J98.4","Z01.419","N81.10","R73.9","J98.11","J47.9","K76.89","C79.52","R07.9","B35.3","B35.1","I51.7","N95.2"],"date":["2026-01-27","2026-03-09","2026-03-08","2026-01-27","2026-03-13","2026-03-13","2026-01-27","2026-01-27","2026-02-20","2026-03-09","2025-07-30","2026-02-19","2026-03-13","2026-03-10","2026-03-12","2024-09-23","2025-12-10","2025-12-09","2024-08-14","2024-09-22","2024-09-22","2024-09-22","2023-08-15","2023-08-15","2023-08-15","2025-09-10","2025-09-10","2025-09-10","2025-10-13","2026-02-19","2025-11-13","2025-11-19","2023-11-26","2024-01-07","2024-01-07","2024-01-07","2026-02-19","2026-02-01","2023-09-01","2024-07-02","2023-12-01","2024-07-02","2026-01-08","2023-06-05","2026-01-08","2023-05-18","2025-11-19","2026-02-19","2025-11-19","2026-03-13","2024-09-23","2026-02-17","2026-01-27","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-05-26","2023-03-20","2026-02-14","2024-03-21","2024-03-21","2024-12-06","2025-09-23","2024-03-28","2023-12-01","2025-02-25","2025-02-25","2024-03-28","2026-02-01","2026-03-09","2025-09-23","2024-01-07","2024-01-07","2025-03-02","2025-03-02","2025-03-02","2025-03-02","2023-07-20","2026-02-14","2026-03-12","2025-10-14","2026-02-14","2025-12-16","2026-03-13","2026-03-13","2023-08-05","2024-03-28","2024-12-05","2026-02-13","2024-09-23","2024-12-05","2023-11-26","2024-03-30","2026-02-19","2024-07-20","2026-02-19","2026-03-06","2026-01-02","2025-10-13","2025-01-13","2025-01-13","2025-01-13","2025-01-13","2025-01-13","2025-01-13","2025-01-13","2025-01-13","2025-01-13","2025-01-07","2024-10-28","2024-09-30","2024-12-05","2024-12-05","2026-03-08","2026-03-07","2024-10-07","2024-02-27","2025-07-24","2025-07-24","2024-10-28","2024-10-28","2024-10-28","2023-07-20","2023-07-20","2024-01-07","2025-10-14","2025-10-14","2026-03-06","2024-06-18","2024-06-18","2024-06-18","2023-02-06","2026-03-06","2023-11-07","2023-11-07","2026-01-26","2024-03-28"],"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":[["","","Stiolto Respimat Inhaler (60)","","","Select","Select",""],["","","Tafinlar","75 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","25 MG","","Select","Select",""],["","","Escitalopram","10 MG","","Select","Select",""],["","","Hydroxyzine Hydrochloride","10 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Mekinist","2 MG","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Eliquis","5 MG","","Select","Select",""],["","","Cefuroxime","500 MG","","Select","Select",""],["","","Hydroxyzine Hcl","10 MG","","Select","Select",""],["","","Comirnaty 2023-24(12Y Up) Vial","","","Select","Select",""],["","","Ketoconazole 2% Cream","","","Select","Select",""],["","","Ciclopirox","80 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Levalbuterol","0.417 MG","","Select","Select",""],["","","Stiolto Respimat Inhal Spray","","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Budesonide","0.25 MG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Oxycodone-Acetaminophen 5-325","","","Select","Select",""],["","","Desvenlafaxine Succnt Er","25 MG","","Select","Select",""],["","","Comirnaty 2024-25(12Y Up) Syrg","","","Select","Select",""],["","","{21 Methylprednisolone","4 MG","","Select","Select",""],["","","Stiolto Respimat","","","Select","Select",""],["","","Desvenlafaxine Er","","","Select","Select",""],["","","{6 Azithromycin","250 MG","","Select","Select",""],["","","Comirnaty 2025-26","","","Select","Select",""],["","","Abrysvo","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","24 Hr Desvenlafaxine Succinate","25 MG","","Select","Select",""],["","","Nitrofurantoin Macrocrystals","","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","Fluarix Trivalent 2024-25 Syrg","","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Benzonatate","100 MG","","Select","Select",""],["","","0.5 Ml Bordetella Pertussis Filamentous Hemagglutinin Vaccine, Inactivated","0.016 MG","","Select","Select",""],["","","0.5 Ml Diphtheria Toxoid Vaccine, Inactivated 4 Unt\/Ml \/ Tetanus Toxoid Vaccine, Inactivated 4 Unt\/Ml Injection [Tdvax]","","","Select","Select",""],["","","Phenazopyridine Hydrochloride","200 MG","","Select","Select",""],["","","Sulfamethoxazole","800 MG","","Select","Select",""],["","","Estradiol","0.1 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":""}]}]}