{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Steven Gagnon","gend":0,"currentgend":"","add":"914 W Waugh St","city":"Dalton","state":"GA","zip":30720,"dob":"1963-05-29","age":"","mstatus":"","insh":"AS1004879001","cliId":"","pno":7065290555,"cno":7065811624,"email":"sagagnon50@gmail.com","ename":"","eno":"","pphy":"Lee Connor","ppno":7065293072,"pcpadd":"1107 MEMORIAL DR STE 100","pcpcity":"DALTON","pcpstate":"GA","pcpzip":30720,"pcpcounty":"","pcpid":"","pcpname":"1107 MEMORIAL DR STE 100","plan":"Alliant","program":"ACA","lob":"2026-Wave-1","region":"","aligned":"N","ano":"","add2":"","add3":"","madd1":"914 W Waugh St","madd2":"","madd3":"","mcity":"Dalton","mstate":"GA","mzip":30720,"pcpfaxno":7065293077,"pcpnpi":1710307129,"currentgendcomment":"","pphycomment":"","uniqueid":313052,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K51.00","I11.0","I50.9","I35.1","Z82.49","Z95.2","Z95.3","M99.05","M54.17","M99.02","M54.6","M99.01","M54.2","R06.02","R79.81","M25.511","R63.0","R10.11","K22.2","K22.9","K44.9","K29.50","K57.30","Z98.0","K64.8","K51.90","I10","Z21","D64.9","Z79.899","I25.10","I73.89","I77.1","H20.12","I50.31","B20","L02.211","J42","F32.A","I65.23","L97.409","I97.89","I48.91","E78.5","H54.7","K21.9","I70.213","I50.33","J96.01","N17.9","E44.0","E87.1","E03.9","E78.00","Z68.25","H26.20","J18.9","E87.6","K65.8","K55.9","J43.9","H20.9","J98.11","Z87.891","F10.90","Z79.01","F41.9","Z86.010","Z12.5","H40.113","E78.01","Z23","D48.5","B07.9","L73.9","I36.1","I37.1","I50.43","K65.1","K56.2","D63.8","D68.9","D75.839","I25.118","Q23.1","R06.09","G47.33","R74.8","R19.7","E55.9","K21.00","F39","K51.918","H25.12","Z00.00","Z95.4","D84.821","R94.31","Z79.620","Z79.82","I49.3","Z13.6","R13.13","R13.14","H25.13","I25.119","Z86.79","R05.1","Z03.818","T81.43X","R53.83","R85.610","J84.10","R06.83","R21","E78.49","I87.2","I35.0","I11.9","U07.1","D69.6","J81.1","J90","I23.1","R79.89","R68.89","J20.8","I50.32","K51.919","Z74.3","Y71.0","I71.9","R91.8","I48.92","J06.9","I51.7","I34.1","J18.1","R13.10","I70.244","I70.92","I49.1","D23.71","Z12.11","K29.60","K22.89","K57.50","J98.4","M25.562","K75.0","N28.1","K63.89","H40.052","R94.5","M54.50","E78.2","R10.84","I50.22","R09.02","I34.0","I70.0","I70.8","S75.011","S75.012","Z20.822","K68.11","K31.A11","K20.90","K38.8","K76.89","B00.52","H26.492","I49.8","I73.9","H44.132"],"date":["2025-09-05","2025-09-22","2025-03-31","2025-09-05","2024-12-23","2025-09-22","2025-11-20","2025-12-03","2025-12-03","2025-12-03","2025-12-03","2025-12-03","2025-12-03","2025-05-12","2025-03-31","2025-03-31","2025-03-31","2025-03-31","2025-09-05","2025-09-05","2025-09-05","2025-09-05","2025-09-05","2025-09-05","2025-09-05","2025-09-22","2025-12-23","2025-09-05","2025-09-22","2025-09-05","2025-09-22","2026-03-18","2025-09-30","2026-02-11","2025-09-22","2026-01-06","2025-09-22","2025-09-22","2025-09-22","2025-12-10","2025-09-22","2025-09-22","2025-09-22","2025-09-23","2025-09-22","2025-09-22","2026-03-19","2025-12-23","2025-07-14","2024-08-11","2024-07-23","2025-04-12","2024-07-23","2026-03-18","2024-07-23","2023-04-05","2024-08-11","2025-04-11","2025-03-31","2025-03-31","2025-08-27","2025-03-31","2025-04-11","2025-08-27","2025-03-31","2025-09-18","2025-03-31","2025-09-05","2025-05-06","2026-02-11","2025-05-06","2024-12-20","2023-09-20","2023-09-20","2023-09-20","2025-06-30","2025-06-30","2025-04-11","2025-06-03","2025-04-22","2025-04-11","2025-04-12","2025-04-11","2025-12-23","2025-12-23","2024-12-10","2024-12-18","2025-02-25","2025-06-03","2025-02-25","2025-09-05","2025-07-22","2025-07-22","2023-05-31","2025-05-06","2025-05-06","2024-08-04","2025-04-11","2024-08-04","2024-08-04","2025-04-11","2025-04-11","2025-09-05","2025-07-10","2024-04-09","2025-05-06","2025-05-12","2024-07-21","2024-07-21","2025-04-22","2025-04-22","2025-09-02","2025-08-27","2025-01-27","2025-03-06","2025-12-16","2025-12-10","2023-11-15","2023-11-15","2023-02-22","2023-11-15","2024-07-27","2024-08-16","2025-04-02","2024-08-04","2023-12-08","2023-12-08","2024-09-16","2024-09-16","2024-08-11","2024-08-11","2024-11-05","2025-04-11","2024-09-16","2023-12-05","2024-10-10","2025-04-12","2024-08-06","2024-07-25","2025-09-22","2025-09-22","2024-08-12","2023-09-20","2025-09-05","2025-09-05","2025-09-05","2025-09-05","2025-04-01","2023-11-14","2025-06-03","2025-06-03","2025-03-31","2023-03-24","2023-11-15","2023-11-15","2023-11-15","2025-04-12","2025-04-05","2025-04-05","2024-07-26","2025-12-10","2025-12-10","2025-11-20","2025-11-20","2023-01-04","2025-04-11","2024-07-25","2024-07-25","2025-03-31","2025-04-11","2023-01-25","2024-06-10","2024-08-12","2025-09-23","2023-03-24"],"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":[["","","Humira Cf Pen","40 MG","","Select","Select",""],["","","Furosemide","40 MG","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","Jardiance","10 MG","","Select","Select",""],["","","Metoprolol Tartrate","100 MG","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Torsemide","20 MG","","Select","Select",""],["","","Eliquis","5 MG","","Select","Select",""],["","","Tramadol Hydrochloride","50 MG","","Select","Select",""],["","","Prevalite Packet","","","Select","Select",""],["","","Valacyclovir","500 MG","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","24 Hr Metoprolol Succinate","50 MG","","Select","Select",""],["","","Mupirocin","0.02 MG","","Select","Select",""],["","","Valsartan","40 MG","","Select","Select",""],["","","Vilazodone Hydrochloride","10 MG","","Select","Select",""],["","","Bictegravir","50 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Hydrocodone Bitartrate\/Acetaminophen","","","Select","Select",""],["","","Valacyclovir Hydrochloride","","","Select","Select",""],["","","Mesalamine","1200 MG","","Select","Select",""],["","","Budesonide","3 MG","","Select","Select",""],["","","Dorzolamide","20 MG","","Select","Select",""],["","","Mesalamine Dr","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Irbesartan","300 MG","","Select","Select",""],["","","Rosuvastatin Calcium","5 MG","","Select","Select",""],["","","Preservative-Free Dorzolamide","20 MG","","Select","Select",""],["","","Prevalite","","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Levofloxacin","750 MG","","Select","Select",""],["","","Nystatin 100000 Unt\/Ml Topical Cream","","","Select","Select",""],["","","Nystatin","","","Select","Select",""],["","","Mnexspike Covid-19 Vaccine\/2025-26","","","Select","Select",""],["","","Sugar-Free Cholestyramine Resin","4000 MG","","Select","Select",""],["","","Ketorolac Tromethamine","5 MG","","Select","Select",""],["","","Moxifloxacin","5 MG","","Select","Select",""],["","","Ketoconazole","20 MG","","Select","Select",""],["","","Dextromethorphan Hydrobromide","3 MG","","Select","Select",""],["","","Pantoprazole Sod Dr","40 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Brimonidine Tartrate","2 MG","","Select","Select",""],["","","Prednisolone Acetate","10 MG","","Select","Select",""],["","","Benzonatate","100 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Nda021457 200 Actuat Albuterol","0.09 MG","","Select","Select",""],["","","Oxycodone Hcl Ir","5 MG","","Select","Select",""],["","","Microencapsulated Potassium Chloride","20 MEQ","","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":""}]}]}