{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dorothy I Smith","gend":1,"currentgend":"","add":"1029 SAWYER RD","city":"GREENE","state":"ME","zip":"04236","dob":"1948-02-28","age":"","mstatus":"","insh":"00008143000","cliId":"","pno":7406458170,"cno":"","email":"ticlaws@icloud.com","ename":"","eno":"","pphy":"WYMAN, PEGGY","ppno":2079465444,"pcpadd":"180 CHURCH HILL RD STE 1,","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1029 SAWYER RD","madd2":"","madd3":"","mcity":"GREENE","mstate":"ME","mzip":"04236","pcpfaxno":2075242093,"pcpnpi":1073592283,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5JQ7MJ7GX59","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z952","E663","Z7901","I739","I2510","H35373","M810","E7800","R739","E559","E782","Z0000","Z1231","M549","M79605","I10","D3132","K219","K449","K222","S2232XA","R32","R911","M79662","R2242","Z87891","Z09","M7989","Z780","I501","I517","I361","R399","T8090XA","S2239XA","R6889","H2511","H2512","H2513","H25013"],"date":["2025-11-17","2024-06-24","2025-10-29","2025-09-24","2025-04-08","2024-11-08","2023-06-29","2023-01-26","2023-01-26","2023-01-26","2024-12-23","2024-10-08","2025-01-24","2024-04-16","2024-08-10","2025-10-02","2023-10-20","2025-07-25","2025-07-25","2025-07-25","2025-04-11","2023-01-03","2024-11-03","2024-08-16","2024-08-10","2024-08-10","2025-10-27","2024-08-09","2023-01-23","2023-12-22","2023-12-22","2023-12-22","2025-02-28","2023-09-15","2025-04-14","2022-10-26","2022-08-30","2022-08-19","2022-07-18","2022-07-18"],"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":[["","","EZETIMIBE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}