{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charlotte P Markie","gend":1,"currentgend":"","add":"12 ORCHARD ST","city":"EAST MILLINOCKET","state":"ME","zip":"04430","dob":"1939-03-26","age":"","mstatus":"","insh":"10000007928","cliId":"","pno":2077465129,"cno":2077238057,"email":"declined@09092024.com","ename":"","eno":"","pphy":"GOLLETTI, JENNI L","ppno":2077235161,"pcpadd":"Millinocket Regional Hospital Family and Internal,200 Somerset St Ste 3","pcpcity":"Millinocket","pcpstate":"ME","pcpzip":"04462","pcpcounty":"","pcpid":"","pcpname":"MILLINOCKET REGIONAL HOSPITAL FAMILY AND INTERNAL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 ORCHARD ST","madd2":"","madd3":"","mcity":"EAST MILLINOCKET","mstate":"ME","mzip":"04430","pcpfaxno":2077234913,"pcpnpi":1841643731,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AC8KN3WP21","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D509","B351","C44319","D500","I083","I10","M79602","M542","I071","I493","E039","H906","M5114","R918","L7632","Z0101","M19011","M25511","M2041","M4802","M50122","M50123","M4722","F32A","M19012","Z1231","R059","M25512","I471","I352","I700","I2720","R5383","K5710","M1811","M151","M152","M5412","D649","R197","Z7982","I350","C4491","E785","M5450","G8929","I4720","M25531","R911","Z0000","K5730","K769","R1032","S46011A","X509XXA","Y939","S3992XA","M25551","M25552","W19XXXA","R531","I110","I5030","R0609","C4441","I081","R0602","R609","M533","I119","R6889","N952"],"date":["2025-08-28","2025-09-16","2024-10-28","2025-01-20","2025-04-25","2024-03-08","2023-03-27","2024-12-12","2023-03-01","2025-02-26","2024-02-20","2025-07-15","2023-07-05","2022-10-13","2024-10-30","2023-11-09","2025-05-06","2025-06-27","2024-06-19","2023-07-05","2023-07-05","2023-07-05","2023-07-05","2022-12-20","2023-03-27","2025-03-11","2024-10-16","2023-05-01","2023-04-26","2025-04-25","2025-04-25","2025-04-25","2024-12-12","2024-10-10","2024-01-22","2024-01-22","2024-01-22","2023-08-30","2025-02-11","2025-02-11","2025-02-11","2024-04-22","2024-06-06","2024-04-23","2025-06-27","2025-06-27","2023-04-05","2024-01-30","2022-10-13","2024-11-20","2024-03-22","2024-03-22","2024-03-22","2023-05-19","2023-05-19","2023-05-19","2025-06-19","2025-06-19","2025-06-19","2025-06-19","2022-11-08","2023-03-08","2023-03-08","2023-03-08","2024-09-12","2023-02-13","2023-02-13","2023-02-13","2025-06-19","2024-07-25","2023-05-07","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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":[]}},{"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":""}]}]}