{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ruth A Stanley","gend":1,"currentgend":"","add":"183 NORRIDGEWOCK RD","city":"FAIRFIELD","state":"ME","zip":"04937","dob":"1942-01-15","age":"","mstatus":"","insh":"00008365500","cliId":"","pno":2074530231,"cno":"","email":"","ename":"","eno":"","pphy":"BARTHOLOMEW, STEPHANIE G","ppno":2074533100,"pcpadd":"4 SHERIDAN RD,","pcpcity":"FAIRFIELD","pcpstate":"ME","pcpzip":"49373314","pcpcounty":"","pcpid":"","pcpname":"FOUR SEASONS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"183 NORRIDGEWOCK RD","madd2":"","madd3":"","mcity":"FAIRFIELD","mstate":"ME","mzip":"04937","pcpfaxno":2078615082,"pcpnpi":1033185988,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3N19A78YY38","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I480","I2510","E7849","Z955","I4819","I10","E6601","I5032","M1712","I4891","Z7901","I110","I5030","I083","M79601","M7989","H6121","Z87891","Z8679","Z8249","R059","R0602","Z789","S4991XD","S42211A","R0600","R918","S4291XA","E039","K2950","K220","M25562","D649","R001","S42211D","R531","I517","I700","S42291A","R634","I4820","I129","N1830","U071","E785","S42201A","R6883","R609","I4892","K5900","K649","R5383","R1013","M25511","M79621","W108XXA","S42291D","S42301D","I4720","S42201D","M79605","M79604","J329","X58XXXD","R42","Z743","M170","M25462","I080","W19XXXD","E7800","H903","K8020","K5730","K449","M25531","G8929","M1811","D509"],"date":["2025-01-28","2025-10-14","2023-10-06","2023-10-06","2025-08-03","2025-10-14","2024-07-16","2025-10-14","2023-07-25","2025-01-31","2024-09-03","2025-11-07","2025-05-12","2025-04-29","2023-12-22","2023-12-22","2025-08-08","2025-08-08","2025-08-08","2025-08-08","2025-05-29","2024-08-22","2024-08-22","2024-04-09","2023-11-04","2023-11-04","2023-11-04","2023-11-04","2025-10-16","2025-09-04","2025-09-04","2023-07-14","2025-08-04","2024-10-07","2023-12-08","2024-08-22","2024-08-22","2024-08-22","2023-12-27","2025-09-19","2024-10-14","2023-07-21","2023-07-21","2022-12-16","2022-12-16","2023-11-08","2025-02-21","2024-10-07","2023-09-27","2023-09-27","2023-09-27","2025-07-15","2025-08-01","2023-11-04","2023-11-04","2023-11-04","2023-11-29","2024-02-06","2025-08-03","2023-11-29","2023-04-18","2023-04-18","2025-05-30","2023-12-27","2023-08-18","2023-08-18","2023-06-30","2023-05-01","2024-02-13","2023-11-15","2025-10-14","2025-10-03","2025-09-19","2025-09-19","2025-09-19","2024-05-07","2024-05-07","2024-05-07","2023-08-12"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","DILTIAZEM 24HR ER (XR)","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DILT-XR","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MELOXICAM","","","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":""}]}]}