{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gail F Olson","gend":1,"currentgend":"","add":"64 FRENCH RD","city":"NORWAY","state":"ME","zip":"04268","dob":"1947-09-02","age":"","mstatus":"","insh":"10000016307","cliId":"","pno":2075272050,"cno":"","email":"declined@062725.com","ename":"","eno":"","pphy":"BENNETT, BRITTANY A","ppno":2078242193,"pcpadd":"Bethel Family Health Center,32 Railroad St","pcpcity":"Bethel","pcpstate":"ME","pcpzip":"04217","pcpcounty":"","pcpid":"","pcpname":"BETHEL FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":4015456781,"add2":"","add3":"","madd1":"64 FRENCH RD","madd2":"","madd3":"","mcity":"NORWAY","mstate":"ME","mzip":"04268","pcpfaxno":"","pcpnpi":1083227664,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9D99W80XV14","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z96641","M12819","M25611","M25551","Z1231","M67442","M25532","Z98890","M2550","M67449","Z96611","M25451","G8929","Z96612","M5134","R7982","E782","M24452","M4802","M5450","Z471","Z96652","M1711","Z0000","Z4802","I10","T84020A","M542","E559","M12811","H1012","S73004A","Z96643","Z01818","G44209","M25561","G894","R051","J439","J929","M19011","D6859","M47816","M4316","T84010D","D62","E039","R4182","M47814","M25511","H0015","Z96649","R109","I700","N261","M9951","M47812","Z981","M4712","R197","G9520","G8918","I340","T84018A","Z86718","S72001A","Z79899","H6123","S73004S","M6281","M5412","M7989","L309"],"date":["2023-10-31","2023-09-25","2023-09-25","2023-08-23","2025-09-03","2024-05-20","2024-06-24","2025-04-01","2024-10-22","2024-03-29","2025-11-11","2023-08-18","2023-04-11","2025-11-11","2025-05-14","2023-08-18","2024-06-26","2025-09-03","2025-11-05","2023-02-10","2023-11-15","2024-06-10","2024-06-10","2025-09-04","2024-06-03","2025-03-20","2023-09-28","2025-01-08","2025-08-11","2023-05-03","2025-08-13","2023-07-28","2023-10-13","2023-09-05","2023-03-30","2024-06-10","2025-05-14","2025-10-01","2025-10-01","2025-10-01","2023-05-03","2023-09-28","2025-05-21","2025-05-21","2023-10-16","2023-10-16","2025-03-20","2025-03-20","2025-05-21","2023-06-29","2025-06-11","2023-10-13","2023-05-31","2023-05-31","2023-05-31","2025-01-21","2025-01-21","2025-03-20","2025-03-20","2023-05-31","2025-01-28","2023-05-03","2023-05-03","2023-09-28","2023-09-28","2023-07-28","2024-02-20","2024-08-01","2023-09-12","2023-10-31","2023-06-06","2023-06-10","2022-10-25"],"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":[["","","NEBIVOLOL HCL","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","CODEINE SULFATE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PAXLOVID (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":""}]}]}