{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dorothy M Howard","gend":1,"currentgend":"","add":"55 NEW YORK ST","city":"MILLINOCKET","state":"ME","zip":"04462","dob":"1944-07-02","age":"","mstatus":"","insh":"00000007392","cliId":"","pno":2077234844,"cno":2077317966,"email":"fthoward981@gmail.com","ename":"","eno":"","pphy":"MILNE, LISA S","ppno":"","pcpadd":"Millinocket Regional Hospital Primary Care RHC,200 Somerset St","pcpcity":"Millinocket","pcpstate":"ME","pcpzip":"04462","pcpcounty":"","pcpid":"","pcpname":"MILLINOCKET REGIONAL HOSPITAL PRIMARY CARE RHC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"55 NEW YORK ST","madd2":"","madd3":"","mcity":"MILLINOCKET","mstate":"ME","mzip":"04462","pcpfaxno":2075282880,"pcpnpi":1396701470,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8X08KX3HX27","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","K5909","E039","H9193","Z23","M84374A","H6990","H9190","H6690","M79671","H6693","Z0101","R6889","Z79899","Z0000","M25511","R6884","N62","E66811","Z1231","J329","Z09","E119","M7731","R7303","M85851","S4991XA","D126","D122","L814","L821","L918","D224","C411"],"date":["2024-05-30","2022-12-07","2024-05-30","2025-01-06","2024-10-11","2023-10-26","2024-09-17","2024-09-17","2024-09-17","2023-11-08","2024-08-15","2024-02-16","2023-12-27","2023-11-22","2025-01-28","2023-07-01","2022-11-30","2025-07-24","2025-09-11","2024-04-24","2022-11-30","2023-01-18","2025-07-17","2023-10-26","2025-02-19","2024-04-24","2023-06-09","2023-01-18","2023-01-18","2023-04-26","2023-04-26","2023-04-26","2023-04-26","2022-11-16"],"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":[["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}