{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sheila C Look","gend":1,"currentgend":"","add":"431 US ROUTE 1","city":"Jonesboro","state":"ME","zip":"04648","dob":"1945-05-02","age":"","mstatus":"","insh":"10000007996","cliId":"","pno":2074346910,"cno":"","email":"Campwench2003@yahoo.com","ename":"","eno":"","pphy":"QUINN, JENNIFER L","ppno":2072552772,"pcpadd":"110 STONE ST,","pcpcity":"ONEIDA","pcpstate":"NY","pcpzip":"13421213","pcpcounty":"","pcpid":"","pcpname":"DOWN EAST HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2074346910,"add2":"","add3":"","madd1":"PO BOX 38","madd2":"","madd3":"","mcity":"Jonesboro","mstate":"ME","mzip":"04648","pcpfaxno":"","pcpnpi":1952670069,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6F12C16WH96","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N3090","Z8589","I10","J302","L03211","H6122","E785","H401131","H524","R109","J00","R059","J069","H44002","H269","R051","R634","H6120","M810","Z1231","D229","Z0000","U071","N390","R42","H9319","S50862A","W57XXXA","H8110","H02402","H26493","H04123","H9202","R062","L821","H43813","R058","H6123","H26491","J329","H26492","H40013","R350","J0100","H9193","H81319","R52","T148XXA","R0981","S80862A","Y92019","B029","Z8616"],"date":["2023-05-26","2023-05-26","2024-05-13","2023-05-26","2023-07-17","2023-12-01","2024-12-18","2025-07-09","2025-07-09","2024-11-06","2023-04-24","2025-06-24","2023-11-24","2023-07-20","2023-07-20","2025-06-24","2025-06-24","2025-01-30","2023-08-30","2023-08-30","2025-01-30","2024-12-18","2024-11-13","2023-05-05","2024-05-23","2024-05-23","2022-11-06","2022-11-18","2024-05-13","2024-06-04","2024-05-01","2024-07-12","2022-11-18","2025-01-14","2025-01-30","2025-01-06","2025-01-14","2025-01-14","2024-05-07","2024-05-13","2024-05-14","2024-03-19","2023-11-24","2023-12-01","2023-12-28","2023-12-15","2022-11-18","2022-11-18","2024-03-01","2022-09-29","2022-09-29","2022-07-11","2022-07-11"],"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":[["","","LATANOPROST","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","PREDNISONE","","","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":""}]}]}