{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbara A Moore","gend":1,"currentgend":"","add":"5 LEWISTON RD","city":"WEST GARDINER","state":"ME","zip":"04345","dob":"1946-05-13","age":"","mstatus":"","insh":"10000012416","cliId":"","pno":2072423868,"cno":"","email":"barbmcm@myfairpoint.net","ename":"","eno":"","pphy":"SAWYER, KENNETH","ppno":2076261561,"pcpadd":"Family Medicine Institute,15 E Chestnut St","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICINE INSTITUTE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 LEWISTON RD","madd2":"","madd3":"","mcity":"WEST GARDINER","mstate":"ME","mzip":"04345","pcpfaxno":2076261849,"pcpnpi":1821720137,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8X73W78PV82","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M3500","K5900","Z634","F4322","Z79899","H43813","Z1231","Z0101","R632","D72819","F419","G4709","M1990","Z7960","R92323","H10503","N8110","N816","F5081","M1811","Z0000","R7309","F418","Z811","Z87828","R768","R002","R079","I351","Z1283","E785","F410","R4189","N760","L570","L719","L409","L821","Z4689","A58","G4710","R42","R0600","I7300","Z1331","R6889","I6523","R0602","Z01419","Z1212","Z1211","E871","G478","G4761","Z23","E538","Z780"],"date":["2025-06-10","2024-09-14","2024-09-13","2025-06-13","2024-11-13","2024-11-13","2025-09-11","2023-11-29","2025-05-08","2023-06-05","2024-11-18","2025-06-10","2025-06-10","2025-06-10","2025-09-11","2023-03-20","2024-10-21","2024-10-21","2024-05-22","2024-01-30","2025-06-11","2024-01-04","2024-01-29","2024-01-29","2024-01-29","2024-01-30","2023-09-07","2023-09-07","2023-09-07","2025-06-02","2024-06-07","2024-06-07","2025-11-05","2025-11-06","2024-06-03","2023-08-31","2023-05-31","2023-05-31","2025-10-20","2025-11-06","2023-08-12","2022-12-05","2022-12-05","2023-06-05","2023-06-05","2022-11-28","2025-10-10","2023-07-11","2025-10-20","2023-08-09","2023-08-09","2024-04-26","2023-08-12","2023-08-12","2022-10-25","2022-08-16","2022-09-01"],"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":[["","","AREXVY","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","TERCONAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","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":""}]}]}