{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Polly P Beatie","gend":1,"currentgend":"","add":"18 SMITHFIELD RD","city":"Belgrade","state":"ME","zip":"04917","dob":"1939-07-25","age":"","mstatus":"","insh":"10000016009","cliId":"","pno":"","cno":2076494902,"email":"","ename":"","eno":"","pphy":"WEBB, TIMOTHY S","ppno":2078726869,"pcpadd":"Elmwood Primary Care,221 Main St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"ELMWOOD PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 SMITHFIELD RD","madd2":"","madd3":"","mcity":"Belgrade","mstate":"ME","mzip":"04917","pcpfaxno":2078773401,"pcpnpi":1376602276,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1G00CK6QT13","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I509","Z7901","I10","F32A","R1310","G4733","A419","J189","G5603","M1A09X0","R7309","M25571","S92912A","J309","M1990","K760","M109","G629","K219","F419","H903","Z0000","I110","K7401","L209","S92535A","H119","H0289","H02132","H02109","R0981","G8929","J22","M19032","M064","R918","R059","I517","L309","D509","R590","R079","N907","I5032","R531","M79672","S92515D","M06839","N750","K317","B372","D239","Z5189","L089","W228XXA","I8500","I82409","H04123","N950","D3131","H35363","Z961","Z0101","G4700","Z79899","H524","H5203","H52223","Z1331","K766","H0012","R162","R160","D649","D696"],"date":["2023-03-23","2025-09-17","2025-09-17","2025-07-22","2024-11-19","2025-10-14","2024-04-03","2024-05-07","2023-06-06","2025-04-22","2025-11-14","2025-09-18","2025-06-13","2023-11-28","2023-02-27","2024-03-07","2023-09-14","2023-08-28","2023-08-28","2025-07-22","2022-12-12","2024-08-23","2024-03-27","2023-03-31","2025-04-09","2025-06-13","2025-01-14","2025-08-14","2025-08-14","2024-10-24","2022-12-05","2022-12-05","2023-02-17","2023-02-27","2023-02-27","2023-02-17","2023-02-27","2023-02-17","2023-02-27","2023-02-03","2024-03-27","2024-03-27","2023-05-03","2025-09-17","2024-03-27","2025-06-13","2025-06-13","2023-03-23","2023-03-23","2023-04-19","2025-02-20","2025-02-20","2023-04-19","2024-12-12","2025-06-13","2023-04-19","2023-09-14","2025-08-14","2023-05-03","2023-06-27","2023-06-27","2023-06-27","2023-06-27","2025-07-22","2025-07-22","2023-06-27","2023-06-27","2023-06-27","2024-08-23","2023-04-19","2022-09-12","2022-09-12","2022-09-09","2022-09-08","2022-09-09"],"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":[["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","LOTEPREDNOL ETABONATE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","TOBRADEX","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}