{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charlotte K Stoddard","gend":1,"currentgend":"","add":"54 CHURCH ST","city":"WASHBURN","state":"ME","zip":"04786","dob":"1944-08-10","age":"","mstatus":"","insh":"10000013399","cliId":"","pno":2075546038,"cno":2077621225,"email":"RICHARDGILBERT801@MSN.COM","ename":"","eno":"","pphy":"MANAGES, SAMUELA E","ppno":"","pcpadd":"PO BOX 40,","pcpcity":"CARIBOU","pcpstate":"ME","pcpzip":"47360040","pcpcounty":"","pcpid":"","pcpname":"PINES ST JOHN VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 212","madd2":"","madd3":"","mcity":"WASHBURN","mstate":"ME","mzip":"04786","pcpfaxno":2074983947,"pcpnpi":1750549044,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7PP8WK7GU25","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H903","I25118","H9319","M47812","R413","E038","R399","I4891","L853","R55","H353131","R059","Z7901","Z87891","Z08","R4189","I3481","R6889","E039","E559","E782","I951","M898X1","R10816","Z5181","R531","R42","I209","M7910","I679","M542","I10","M6281","G9389","K219","Z1231","Z13820","M8589","Z780","R29898","R5382","R942"],"date":["2024-09-26","2025-05-14","2024-09-26","2025-06-10","2025-08-29","2024-07-09","2024-12-06","2025-02-10","2024-04-10","2025-05-12","2024-10-10","2024-06-12","2024-06-12","2024-06-12","2023-12-12","2025-05-13","2025-02-04","2023-12-15","2025-08-15","2023-11-01","2023-11-01","2025-02-04","2025-06-27","2024-04-22","2024-04-12","2024-09-19","2024-04-22","2025-02-08","2024-04-30","2025-08-19","2025-06-27","2024-11-14","2024-07-03","2025-05-08","2024-05-14","2024-05-10","2024-05-10","2024-05-10","2024-05-10","2024-04-24","2024-06-18","2023-11-15"],"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":[["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","BETAMETHASONE VALERATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","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":""}]}]}