{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gail S Smith","gend":1,"currentgend":"","add":"5 SHORELAND DR","city":"BELFAST","state":"ME","zip":"04915","dob":"1941-10-18","age":"","mstatus":"","insh":"00007883600","cliId":"","pno":2073383704,"cno":2075050973,"email":"Douggail2@roadrunner.com","ename":"","eno":"","pphy":"GRANT, CORINNE N","ppno":2075054970,"pcpadd":"WCMP Family Medicine,9 Fahey St","pcpcity":"Belfast","pcpstate":"ME","pcpzip":"04915","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2073383704,"add2":"","add3":"","madd1":"5 SHORELAND DR","madd2":"","madd3":"","mcity":"BELFAST","mstate":"ME","mzip":"04915","pcpfaxno":2073381691,"pcpnpi":1750720082,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1UX4J24CY86","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1211","Z86010","D122","D123","C44319","Z0000","H353221","H353112","R059","J329","R079","R0789","R002","L570","C441192","J0190","H6590","R0600","R6889","Z23","H40013","D489","M9905","M4607","M9903","M5450","J069","R112","R110","D124","Z0101","H353124","H353111","Z961","R058","R7301","R3989","Z1231","K5900","F411","K449","K317","K2960","Z79811","M9902","M546","M9901","M542","K219","K580","L578","R197","L821","Z1283","Z85828","H903","M8589","H6991","I209","U071","R109","K2970","H16223","H0288A","H0288B","H04123","H1045","H04121","M79645","H25811","H25812"],"date":["2023-07-21","2023-07-21","2023-07-21","2023-07-21","2024-06-24","2024-06-04","2025-10-02","2024-11-07","2024-01-02","2024-12-09","2023-04-25","2023-10-24","2023-08-15","2023-04-10","2024-03-15","2024-11-25","2025-08-05","2024-01-02","2023-05-26","2024-09-30","2024-11-07","2024-02-09","2025-09-22","2025-09-22","2025-09-22","2025-09-22","2023-12-08","2024-12-31","2025-10-29","2023-07-21","2025-09-02","2025-09-02","2025-09-02","2025-09-02","2024-01-02","2024-06-04","2024-10-04","2025-11-07","2025-10-29","2025-10-31","2024-04-05","2024-04-05","2024-04-05","2024-04-05","2024-08-05","2024-08-05","2024-08-05","2024-08-05","2025-02-14","2025-10-10","2025-07-09","2025-02-14","2025-07-09","2025-07-09","2025-07-09","2025-10-14","2024-07-19","2025-06-13","2023-05-03","2024-08-18","2024-09-02","2024-04-05","2022-11-04","2022-11-04","2022-11-04","2022-09-27","2022-09-09","2022-09-09","2022-08-02","2022-07-11","2022-06-20"],"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":[["","","RESTASIS","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","PROCTO-MED HC","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","CYCLOSPORINE","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","PROMETHAZINE HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","RESTASIS MULTIDOSE","","","Select","Select",""],["","","PROCTOZONE-HC","","","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":""}]}]}