{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nikki Lee Lance","gend":1,"currentgend":"","add":"121 John Smith Way","city":"Blairsville","state":"GA","zip":30512,"dob":"1987-07-01","age":"","mstatus":"","insh":"0003925279002","cliId":"","pno":7625250425,"cno":7625250425,"email":"nlance5959@gmail.com","ename":"","eno":"","pphy":"Laci Myers","ppno":7062452111,"pcpadd":"35 HOSPITAL RD","pcpcity":"BLAIRSVILLE","pcpstate":"GA","pcpzip":305123139,"pcpcounty":"","pcpid":"","pcpname":"35 HOSPITAL RD","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"121 John Smith Way","madd2":"","madd3":"","mcity":"Blairsville","mstate":"GA","mzip":30512,"pcpfaxno":"","pcpnpi":1457518813,"currentgendcomment":"","pphycomment":"","uniqueid":271372,"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":["E06.3","I50.9","R53.1","R25.1","E05.90","Z68.30","G62.9","F17.210","F17.290","R19.7","G89.29","G82.50","E51.9","M87.19","M21.371","M21.372","K90.0","R33.9","R11.0","E83.39","I27.20","I50.83","E04.1","Z88.5","Z88.8","G60.9","C73","R11.2","M54.31","N83.201","R11.15","F17.200","N17.9","R79.89","E87.6","N39.0","F12.10","R29.898","M87.052","M87.051","Z68.29","G62.89","M62.81","M54.50","M79.10","R26.81","R20.2","T38.0X5","R14.0","K21.9","K64.8","K59.00","Z85.850","E89.0","J20.9","M79.18","E51.11","E51.12","I95.9","M54.12","R57.1","E27.2","E87.20","E27.40","M87.9","G60.3","K52.9","F31.9","F41.9","R73.9","F12.90","E55.9","Z79.52","Z87.440","R77.8","Z88.1","Z00.00","M79.641","M79.642","G56.21","R00.2","I95.1","R06.09","E66.9","M79.89","R94.31","Z76.89","Z68.32","Z01.812","M54.59","E28.39","M54.17","Z79.899","D72.9","R60.0","Z90.710","Z98.51","Z98.82","Z82.49","Z82.69","G56.03","R52","S34.119","G89.4","Z79.891","Z01.818","M54.2","M79.606","Z51.81","M51.17","M25.879","M79.2","Z68.27","R57.9","S16.1XX","S80.02X","M79.604","M79.605","M79.601","M79.602","M54.9","R53.81","R26.89","M87.10","B35.1","Z13.31","S91.201","L03.031","S91.202","E01.0","R65.21","R94.6","R51.9","J98.4","N32.89","M89.9","M50.222","M51.27","F39","Z68.28","M25.561","M25.562","L03.032","L60.0","R19.09","S32.038","Z68.26","G54.2","R20.0","M47.812","M62.838","Z71.89","R10.0","Z78.0","Z86.39","G82.20","Z04.1","V89.9XX","G45.2","F41.1","F43.29","A41.9","R23.2","R05.9","F32.0","R45.89","K29.70","N31.9","R10.31","R10.32","E04.9","R63.5","R07.9","M48.02","Z60.9","Z13.820","S90.32X","M79.672","Z68.31","L68.0","N95.1","E66.3","I36.1","R57.8"],"date":["2026-01-22","2024-06-25","2023-11-22","2023-09-26","2026-01-21","2024-12-12","2026-02-05","2024-03-20","2024-03-20","2023-11-21","2026-01-23","2024-05-22","2023-12-01","2023-12-01","2024-01-25","2024-01-25","2024-06-25","2024-01-03","2025-08-13","2023-12-17","2023-12-01","2024-07-15","2024-02-17","2023-12-01","2023-12-01","2024-09-13","2024-05-13","2023-11-22","2023-11-16","2023-11-16","2023-11-16","2023-11-16","2023-11-22","2024-02-29","2023-11-22","2023-11-21","2023-11-21","2023-11-21","2023-11-21","2023-11-21","2024-12-30","2024-06-25","2023-11-30","2025-03-26","2024-08-08","2023-02-22","2023-07-07","2023-11-22","2025-08-13","2025-08-13","2025-08-13","2025-08-13","2026-01-22","2026-01-22","2023-01-29","2024-09-12","2024-01-11","2025-03-26","2024-03-13","2026-02-05","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2024-04-11","2024-07-18","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2023-11-09","2023-08-24","2025-03-26","2024-11-22","2024-11-22","2024-12-18","2024-03-13","2023-10-27","2024-01-03","2023-10-27","2023-10-27","2024-03-06","2023-10-27","2023-10-27","2024-12-12","2023-12-21","2024-02-26","2025-01-09","2023-09-19","2024-02-13","2023-11-09","2023-11-09","2023-11-09","2023-11-09","2023-11-09","2023-11-09","2024-10-30","2023-11-21","2023-11-21","2026-02-05","2026-02-05","2024-12-12","2023-07-31","2023-12-02","2023-06-30","2024-04-26","2024-05-22","2024-08-08","2024-04-11","2024-01-25","2023-06-01","2023-06-01","2023-04-28","2023-04-28","2023-01-09","2023-01-09","2023-01-09","2023-01-09","2023-01-09","2024-05-22","2024-09-13","2024-09-13","2024-09-13","2024-09-13","2024-09-13","2023-08-21","2023-11-25","2024-03-13","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2023-11-22","2026-01-23","2026-01-23","2024-08-08","2024-08-08","2024-08-16","2024-08-30","2023-11-16","2023-11-16","2024-03-13","2023-09-08","2023-09-08","2026-02-05","2023-11-23","2023-07-31","2023-11-21","2024-10-29","2025-11-29","2023-11-23","2023-06-01","2023-06-01","2023-09-08","2025-03-26","2024-09-05","2023-12-01","2024-02-13","2023-01-29","2024-08-12","2024-08-12","2023-09-12","2024-03-06","2023-11-21","2023-11-21","2023-08-07","2023-08-07","2023-06-01","2023-07-07","2024-06-06","2024-10-29","2023-03-20","2023-03-20","2024-09-17","2024-02-26","2024-02-26","2024-02-26","2023-11-22","2023-11-29"],"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":[["","","Prednisone","20 MG","","Select","Select",""],["","","Paroxetine Hydrochloride","30 MG","","Select","Select",""],["","","Pregabalin","100 MG","","Select","Select",""],["","","Ergocalciferol","1.25 MG","","Select","Select",""],["","","Meloxicam","7.5 MG","","Select","Select",""],["","","Methocarbamol","750 MG","","Select","Select",""],["","","Sucralfate","1 GM","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Nitrofurantoin, Macrocrystals","25 MG","","Select","Select",""],["","","Diazepam","2 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Trazodone Hydrochloride","100 MG","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Sevelamer Carbonate","800 MG","","Select","Select",""],["","","Calcitriol","0.00025 MG","","Select","Select",""],["","","Cholestyramine Resin","4000 MG","","Select","Select",""],["","","Levothyroxine Sodium","0.15 MG","","Select","Select",""],["","","Fluoxetine","10 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Morphine Sulfate Ir","15 MG","","Select","Select",""],["","","Buprenorphine","0.6 MG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Morphine Sulfate","","","Select","Select",""],["","","12 Hr Tapentadol","100 MG","","Select","Select",""],["","","Anucort-Hc","","","Select","Select",""],["","","Hydrocodone\/Acetaminophen","","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Methimazole","5 MG","","Select","Select",""],["","","Levothyroxine","100 MCG","","Select","Select",""],["","","24 Hr Bupropion Hydrochloride","150 MG","","Select","Select",""],["","","Hydrocodone-Acetamin 7.5-325","","","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":""}]}]}