{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean C Mullenaux","gend":1,"currentgend":"","add":"84 CASTLE VIEW LN","city":"BELGRADE","state":"ME","zip":"04917","dob":"1943-10-21","age":"","mstatus":"","insh":"00000007172","cliId":"","pno":6175051383,"cno":6175051383,"email":"","ename":"","eno":"","pphy":"COHEN, KELLY","ppno":2078726869,"pcpadd":"Belgrade Regional Health Center,4 Clement Way","pcpcity":"Belgrade","pcpstate":"ME","pcpzip":"04917","pcpcounty":"","pcpid":"","pcpname":"BELGRADE REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2079851536,"add2":"","add3":"","madd1":"PO BOX 65","madd2":"","madd3":"","mcity":"BELGRADE","mstate":"ME","mzip":"04917","pcpfaxno":2078773401,"pcpnpi":1154973725,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4K37MT6HV20","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z950","H5213","H52223","M8589","Z780","I495","Z0000","E039","E785","F32A","E119","I739","H18513","H43813","Z961","Z0101","L570","L853","D225","L814","L821","M353","G4700","M79661","D229","Z7189","R5383","M810","Z13820","R252","J209","J029","R062","R0982","H18512","Z947","M25472","M25471","K760","R109","R7989"],"date":["2024-06-11","2024-08-05","2024-08-05","2023-07-20","2023-07-20","2025-07-28","2023-05-30","2024-06-18","2024-08-08","2023-05-30","2025-07-03","2025-07-28","2023-05-23","2023-05-23","2023-05-23","2023-05-23","2024-08-08","2024-08-08","2024-08-08","2024-08-08","2024-08-08","2023-06-21","2023-08-24","2023-08-22","2023-07-17","2023-07-17","2023-07-06","2025-08-28","2025-08-28","2024-08-08","2023-04-12","2023-04-12","2023-04-12","2023-04-12","2025-08-01","2025-08-01","2023-07-06","2023-07-06","2022-08-18","2022-08-18","2022-08-18"],"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":[["","","SERTRALINE HCL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}