{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan A Davis","gend":1,"currentgend":"","add":"406 BUCKS MILLS RD","city":"BUCKSPORT","state":"ME","zip":"04416","dob":"1939-02-16","age":"","mstatus":"","insh":"10000014855","cliId":"","pno":2074692335,"cno":"","email":"DAVISBUSH@ROADRUNNER.COM","ename":"","eno":"","pphy":"GILLIGAN, SAMANTHA P","ppno":2073386900,"pcpadd":"Seaport Community Health Center,29 Schoodic Dr","pcpcity":"Belfast","pcpstate":"ME","pcpzip":"04915","pcpcounty":"","pcpid":"","pcpname":"COMMUNITY CARE AND GERIATRICS","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"406 BUCKS MILLS RD","madd2":"","madd3":"","mcity":"BUCKSPORT","mstate":"ME","mzip":"04416","pcpfaxno":2073386944,"pcpnpi":1689079279,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3PM6TW0MC89","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I517","I340","I361","G8918","G4733","Z23","J189","S72141D","Z0101","H5201","H52223","H524","S72141A","I480","E785","G309","M8580","M4850XA","R509","M810","Z8673","F0280","F0150","M8008XD","K5730","M5409","S70361A","W57XXXA","Z01812","E871","R110","R7989","M47816","M533","M80851A","S32050A","S22080A","G301","M4854XD","M4856XD","R030","F02A0","M5459","N859","M419","M5450","Z853","M80051D","Z952","R531","R350","R031","R000","S72121A","G4719","H401111","R262","R413","D696","H40012","K869","H1131","R935","D259","B351","M79674","L602","M79675","M5136","Z0000","H5212","H2512","H401114","H43813","J9811","R0602","S79811A","R9082","G319","H10021","H1011","H11431","I999","H401112","H47233","E875","S22080D","M80051A","F0390","M8008XA","S72091A","L820","L538","L821","L814","Z79899","S72091D","I491","S0990XA","H908","H401412","H43811","D485","I4891","Z7901","Z7982","Z7189","Z08"],"date":["2024-02-12","2024-02-12","2024-02-12","2025-03-09","2024-10-30","2024-10-17","2024-07-20","2025-08-28","2025-01-08","2025-01-08","2025-01-08","2025-01-08","2025-03-11","2025-03-11","2025-03-09","2025-02-04","2024-08-12","2023-07-10","2024-06-13","2023-03-29","2024-02-14","2024-02-14","2024-02-14","2023-05-09","2024-09-24","2023-08-23","2023-07-01","2023-07-01","2024-09-09","2024-06-20","2023-04-12","2023-04-25","2023-02-27","2023-02-27","2025-03-08","2023-04-14","2023-04-14","2024-07-11","2023-05-09","2023-08-23","2024-06-10","2023-10-03","2023-08-11","2024-09-24","2024-09-17","2023-02-27","2023-02-27","2025-06-24","2025-08-14","2024-06-17","2024-06-10","2024-06-12","2024-06-10","2025-08-28","2023-06-30","2025-04-07","2025-03-25","2023-09-18","2024-06-12","2024-07-03","2024-09-17","2023-05-31","2024-09-24","2024-09-24","2025-06-18","2025-06-18","2025-06-18","2025-06-18","2023-03-10","2025-02-21","2022-10-19","2022-10-19","2022-12-14","2023-08-02","2024-06-13","2024-06-13","2025-03-08","2023-09-18","2023-09-18","2023-07-26","2023-07-26","2023-07-24","2023-09-18","2025-06-05","2025-06-05","2024-06-21","2023-03-28","2025-03-09","2025-03-11","2023-03-28","2025-03-08","2024-05-28","2024-05-28","2024-05-28","2024-05-28","2023-03-28","2025-03-08","2024-07-19","2025-03-08","2024-12-02","2022-08-22","2022-08-22","2022-07-26","2022-07-14","2022-07-14","2022-07-14","2022-06-14","2022-06-14"],"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",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CALCITONIN-SALMON","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","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":""}]}]}