{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary L Dailey","gend":1,"currentgend":"","add":"289 MAIN ST","city":"RICHMOND","state":"ME","zip":"04357","dob":"1941-07-06","age":"","mstatus":"","insh":"10000016066","cliId":"","pno":2077378001,"cno":"","email":"declined@031523.com","ename":"","eno":"","pphy":"BARTOL, THOMAS G","ppno":2072136713,"pcpadd":"Family Focused Healthcare,219 Capitol St Ste 5","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"FAMILY FOCUSED HEALTHCARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"289 MAIN ST","madd2":"","madd3":"","mcity":"RICHMOND","mstate":"ME","mzip":"04357","pcpfaxno":2072136785,"pcpnpi":1841262417,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5J88KT1FN27","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0100","Z79899","N814","I351","I358","H9201","R21","M25562","L600","L570","M79671","M7741","L852","M7740","M129","M792","R600","M0609","M7989","M19071","M79674","M79672","G608","M1712","B351","R519","I672","R9089","J322","M1A0710","M1A4710","R059","Z466","M25561","G8929","G459","M10071","M069","M1990","M4322","S162XXA","M542","R29818","M0899","R531","I6523","E042","B070","M20012","L539","L299","R262","L84","M10171","L603","L249","I87311","N390","Z0000","Z13220","M109","L309","M1A9XX0","L851","M79645","Z01818","H6123","S62667D","S161XXA","M10471","Z23","S62637A","S62307A","M2351","Z7961","H6121","Z96651","R509","M85871","L292","S199XXA","M549","W19XXXA","M25462","S62639A","L239","E559","R296","G319","D2371","Z7189","Z9181","H02833","H02836","G609","L858","N3000","Z96649","Z96641","T8489XD","Z09","A000","T84020D","M25551","T84021A","M24451","M25351","R9431","T84020A","E669","K648","Z96643","K4090","S73004A"],"date":["2025-02-11","2025-02-11","2025-06-18","2023-10-09","2023-10-09","2024-11-12","2023-10-24","2025-04-24","2024-11-01","2025-02-07","2024-08-01","2023-08-31","2024-01-25","2024-04-09","2024-01-25","2023-02-01","2025-03-05","2025-08-20","2024-05-03","2024-05-03","2024-05-03","2023-02-01","2023-02-01","2025-08-20","2025-03-21","2023-11-16","2023-11-16","2023-11-16","2023-11-16","2025-04-28","2025-02-25","2025-11-07","2025-06-18","2024-03-29","2025-04-24","2023-10-13","2024-07-16","2024-07-16","2024-07-16","2024-07-16","2023-11-16","2023-11-16","2023-10-08","2024-08-01","2024-08-01","2023-10-08","2023-10-08","2024-09-17","2024-04-25","2023-10-18","2023-10-18","2024-04-09","2024-07-25","2024-07-15","2023-09-26","2025-08-18","2022-12-16","2023-10-09","2025-03-19","2025-03-19","2024-08-01","2025-06-17","2024-06-18","2025-06-20","2024-04-06","2025-06-20","2023-02-14","2024-06-05","2023-11-16","2024-08-21","2023-11-09","2024-04-06","2024-04-06","2024-02-20","2025-02-25","2024-10-03","2024-03-29","2024-07-15","2023-03-10","2024-12-19","2023-11-16","2023-11-16","2023-11-16","2024-02-18","2024-04-06","2025-05-20","2023-11-02","2023-11-02","2023-10-09","2023-08-07","2025-08-20","2025-08-20","2024-02-09","2024-02-09","2023-02-01","2023-02-01","2023-10-17","2022-11-10","2022-11-22","2022-09-14","2022-09-16","2022-09-14","2022-09-01","2022-08-19","2022-08-09","2022-08-30","2022-08-26","2022-08-12","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-08-15","2022-08-09"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","LIDOCAINE-PRILOCAINE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MUPIROCIN","","","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":""}]}]}