{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lainey Mathis","gend":1,"currentgend":"","add":"717 Trammell St","city":"Dalton","state":"GA","zip":30720,"dob":"2003-07-25","age":"","mstatus":"","insh":"0004884064001","cliId":"","pno":7063134816,"cno":7063134816,"email":"Cadenmathis03@gmail.com","ename":"","eno":"","pphy":"CRYSTAL BRANCH","ppno":4236673366,"pcpadd":"1200 MEMORIAL DRIVE","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"1200 MEMORIAL DRIVE","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"717 Trammell St","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":30720,"pcpfaxno":"","pcpnpi":1144006750,"currentgendcomment":"","pphycomment":"","uniqueid":358430,"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":["R00.0","R11.2","R19.7","M62.81","R68.89","G93.5","Q04.8","Z86.69","Z98.890","G90.A","G90.1","O26.892","R10.9","Z3A.24","R53.1","Q07.00","E86.0","R51.9","Z88.8","Z79.899","G89.18","O26.893","Z3A.31","J02.9","E27.49","O35.2XX","O34.02","Q51.3","Z3A.17","G97.41","F32.A","I10","R32","Z91.040","Z91.041","K21.9","R20.0","F41.1","F44.4","G83.9","E87.8","R73.9","R11.0","R42","Z20.822","G50.9","Z86.16","Z91.048","G95.0","R10.13","R00.2","I49.8","Z36.1","Z3A.16","R27.0","N94.10","N93.8","R10.2","R56.9","G43.909","R63.4","M43.6","G90.89","H81.399","R63.0","Z68.21","T50.905","R00.1","O36.813","F41.9","I25.2","I95.1","Z74.01","N94.6","F43.10","G90.9","M79.2","O47.02","R06.02","Z37.0","O99.354","Z3A.39","O71.82","O70.1","O35.8XX","Z3A.36","E83.42","F43.20","G44.099","Z86.11","N83.291","O99.283","Z3A.34","Z3A.32","Z3A.23","M79.10","M25.50","R26.2","Z91.128","N39.498","M21.371","M21.372","D68.9","O80","N92.6","R94.31","O99.342","O99.352","Z88.5","N76.0","Z03.818","B34.9","I49.9","I23.1","Z13.6","Z3A.25","Z87.728","R07.2","R06.09","R07.89","R55","R29.898","R07.9","R68.83","R10.816","R79.9","R53.81","R53.83","O34.01","Z3A.13","F44.9","K56.609","G44.219","R29.818","Z30.8","Z3A.28","Z68.22","Z39.1","Z34.82","Z34.83","J98.4","I51.7","Z13.1","Z3A.22","R23.2","R03.0","L30.4","G43.809","I47.11","O60.03","D84.9","R06.82","O34.03","O99.353","I95.89","Z79.3","Z79.01","O99.285","O90.89","O99.355","Z30.09","I45.19","O41.93X","Z3A.38","F41.8","N92.0","N83.201","M96.1","Z48.811","O47.00","O60.02","R10.30"],"date":["2024-12-25","2025-04-09","2024-10-02","2025-10-28","2025-03-28","2025-10-28","2025-04-08","2025-04-08","2025-08-23","2025-11-19","2025-10-25","2023-03-18","2024-09-04","2023-03-22","2025-10-25","2025-10-25","2023-07-02","2024-09-30","2025-04-08","2025-04-08","2025-04-09","2023-06-10","2023-05-04","2025-10-27","2025-10-28","2023-03-07","2023-03-15","2023-06-28","2023-01-31","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-04-08","2025-10-25","2025-11-15","2025-10-25","2025-10-25","2025-10-25","2025-10-25","2025-10-25","2025-10-25","2024-09-30","2025-10-24","2024-09-30","2024-12-24","2024-12-24","2024-10-25","2025-03-18","2024-09-04","2026-03-06","2024-12-24","2023-01-19","2023-01-19","2025-08-23","2025-01-23","2025-01-23","2025-01-23","2024-10-30","2025-01-03","2024-10-30","2024-10-30","2024-10-30","2024-10-30","2024-10-30","2024-10-30","2024-10-30","2025-04-04","2023-06-10","2026-03-06","2024-10-26","2026-03-06","2024-10-26","2024-11-14","2025-01-02","2025-04-08","2025-04-08","2023-03-18","2024-09-05","2023-06-29","2023-06-28","2023-06-29","2023-06-28","2023-06-28","2023-06-14","2023-06-14","2024-12-24","2024-12-27","2024-12-24","2024-12-24","2024-12-24","2023-05-25","2023-05-25","2023-05-16","2023-03-15","2024-12-12","2024-12-12","2025-02-05","2024-09-10","2025-02-05","2025-02-05","2025-02-05","2025-03-31","2023-06-29","2024-11-19","2024-12-27","2023-03-18","2023-03-18","2023-03-18","2023-03-22","2024-04-11","2024-04-11","2024-12-28","2024-12-27","2024-12-27","2023-03-27","2025-04-08","2025-08-21","2026-03-06","2024-09-09","2025-01-01","2025-10-25","2024-12-24","2024-09-04","2024-09-04","2024-09-04","2024-09-04","2024-09-04","2023-01-03","2023-01-03","2025-10-24","2024-09-30","2024-09-30","2025-10-24","2025-10-22","2023-04-19","2024-10-28","2023-03-28","2023-03-28","2023-03-28","2025-04-04","2024-12-24","2023-04-19","2023-03-07","2025-11-19","2025-11-19","2023-01-20","2024-10-26","2025-05-07","2023-05-25","2024-11-02","2024-12-24","2023-06-10","2023-06-10","2024-10-26","2024-10-26","2024-10-26","2023-07-02","2023-07-02","2023-07-02","2024-11-14","2024-10-02","2023-06-23","2023-06-23","2024-10-29","2024-12-27","2024-12-27","2025-07-06","2025-07-06","2023-03-17","2023-03-15","2023-03-15"],"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":[["","","Propranolol","10 MG","","Select","Select",""],["","","Indomethacin","25 MG","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Midodrine Hcl","2.5 MG","","Select","Select",""],["","","Famotidine","20 MG","","Select","Select",""],["","","Sertraline","50 MG","","Select","Select",""],["","","Propranolol Hydrochloride","20 MG","","Select","Select",""],["","","Desmopressin Acetate","0.2 MG","","Select","Select",""],["","","Clindamycin","150 MG","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Midodrine Hydrochloride","2.5 MG","","Select","Select",""],["","","Sucralfate","1 GM","","Select","Select",""],["","","Escitalopram","20 MG","","Select","Select",""],["","","Lo Loestrin Fe 1-10 Tablet","","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","Guanfacine","1 MG","","Select","Select",""],["","","Pyridostigmine Bromide","60 MG","","Select","Select",""],["","","Ivabradine Hydrochloride","","","Select","Select",""],["","","{21 Ethinyl Estradiol","0.02 MG","","Select","Select",""],["","","24 Hr Propranolol Hydrochloride","80 MG","","Select","Select",""],["","","Lo Loestrin Fe","","","Select","Select",""],["","","Guanfacine Hydrochloride","","","Select","Select",""],["","","Clonidine Hydrochloride","0.1 MG","","Select","Select",""],["","","Amoxicillin","","","Select","Select",""],["","","Pantoprazole","20 MG","","Select","Select",""],["","","Clotrimazole-Betamethasone Crm","","","Select","Select",""],["","","Hyoscyamine Sulfate","0.125 MG","","Select","Select",""],["","","Penicillin V Potassium","500 MG","","Select","Select",""],["","","Ivabradine Hcl","5 MG","","Select","Select",""],["","","Cyclobenzaprine Hydrochloride","10 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":""}]}]}