{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Priscilla Look","gend":1,"currentgend":"","add":"24 OLD HOUSE PT","city":"Jonesport","state":"ME","zip":"04649","dob":"1947-03-20","age":"","mstatus":"","insh":"10000017304","cliId":"","pno":2074975592,"cno":"","email":"","ename":"","eno":"","pphy":"BARBEE, KRISTEN","ppno":2075462391,"pcpadd":"ONE MEDICAL CENTER DRIVE,","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"04005","pcpcounty":"","pcpid":"","pcpname":"MILBRIDGE MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 OLD HOUSE PT","madd2":"","madd3":"","mcity":"Jonesport","mstate":"ME","mzip":"04649","pcpfaxno":2072846291,"pcpnpi":1215166533,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1MQ6JD3HC42","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I083","M5450","H72822","H9210","H9319","H903","Z45018","H7292","I2510","I509","I255","M9904","S336XXA","M9903","M9902","H7191","Z8669","H6991","M549","R300","D3131","D3132","H7193","M1712","H90A12","M25569","H6591","M25562","M170","H43813","H2513","Z0000","R21","H9193","H6983","H9313","I517","J988","Z01810","J209","H6123","S0922XA","Z48810","M5416","M461","H90A32","H9212","I350","Z0001","M5441","Z950","M5430","H6092","H9012","H6063","M47816","M1990","M5136","M5116","M4726","M4316","Z79899","R399","H6093","Z1231","R609","F40240","L723","M48061","M5126","M47817","Z87442","M5431","I10","Z7982","I110","I5020","M85851","M85852","H6060","H6120"],"date":["2025-07-29","2024-07-23","2023-10-24","2023-10-12","2023-10-24","2024-08-22","2025-08-08","2024-03-07","2025-07-29","2025-07-29","2025-07-29","2023-08-02","2023-08-02","2023-08-02","2023-08-02","2024-08-22","2024-08-22","2024-08-22","2023-11-02","2025-07-08","2024-04-24","2024-04-24","2024-11-22","2025-09-08","2024-02-02","2024-08-28","2024-07-30","2025-01-06","2024-07-24","2023-04-13","2023-04-13","2025-03-25","2025-07-08","2023-11-16","2023-11-16","2023-11-16","2022-12-28","2024-01-24","2025-05-13","2024-10-04","2024-11-22","2023-11-01","2024-06-26","2024-03-06","2025-07-29","2024-06-26","2023-10-24","2022-12-28","2022-12-01","2023-08-16","2023-08-09","2023-08-07","2023-09-08","2024-02-28","2023-09-26","2024-05-15","2025-01-06","2023-09-19","2023-09-19","2023-09-19","2024-05-15","2023-08-23","2024-03-12","2025-07-02","2024-05-08","2023-08-23","2023-08-23","2023-02-16","2023-09-19","2023-09-19","2023-09-19","2024-07-03","2023-07-31","2023-07-31","2023-07-31","2023-08-16","2023-08-16","2024-05-08","2024-05-08","2023-09-08","2023-09-08"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PAXLOVID","","","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":""}]}]}