{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Suzanne M Trudel","gend":1,"currentgend":"","add":"36 COLLEY HILL","city":"GRAY","state":"ME","zip":"04039","dob":"1941-04-08","age":"","mstatus":"","insh":"10000009669","cliId":"","pno":2079399915,"cno":2073292435,"email":"declined@01212022.com","ename":"","eno":"","pphy":"Kim, Regina Y","ppno":2075351340,"pcpadd":"MERCY WEST FALMOUTH PRIMARY CARE,75 GRAY RD","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"04105","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 354","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":2075351358,"pcpnpi":1104906155,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8KU0V42YN44","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H25812","L570","C44529","D492","L7632","Z85828","L821","D1801","L814","M75122","S46112A","Z4802","E785","Z1231","Z0000","I82599","Z7189","R5383","C44519","H903","D225","M25512","M25412","M75102","T8130XA","R29898","Z87891","Z86718","Z7901","J449","R059","J9811","C44511","M8580","M19012","H2512","R58"],"date":["2024-06-18","2024-11-12","2022-11-30","2024-11-12","2025-02-07","2023-11-07","2024-11-12","2024-11-12","2024-11-12","2024-03-18","2024-03-18","2025-02-14","2023-09-08","2023-09-22","2024-09-20","2023-09-08","2023-09-08","2023-09-08","2025-02-07","2023-03-06","2024-11-12","2024-02-19","2024-01-31","2024-02-19","2025-02-07","2024-02-02","2024-02-02","2024-01-31","2025-02-07","2023-01-07","2023-01-07","2023-01-07","2025-02-07","2024-01-31","2024-01-31","2024-06-18","2025-02-07"],"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",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}