{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Constance Welch","gend":1,"currentgend":"","add":"171 MOUNTFORT RD","city":"North Yarmouth","state":"ME","zip":"04097","dob":"1943-11-11","age":"","mstatus":"","insh":"10000017313","cliId":"","pno":2078464282,"cno":"","email":"declined@072020.com","ename":"","eno":"","pphy":"RICHARDS, SAMANTHA","ppno":2077984050,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"171 MOUNTFORT RD","madd2":"","madd3":"","mcity":"North Yarmouth","mstate":"ME","mzip":"04097","pcpfaxno":2077984018,"pcpnpi":1689960114,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5AW1HG0AJ23","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R531","I700","G309","A000","R2681","M1A9XX1","F0280","S0990XA","H6123","E876","L84","L603","M79671","M79672","R262","D239","L919","D510","F0390","I10","D509","E871","R410","R2689","R739","M109","E7800","B950","S0512XA","F1021","M67471","M1990","S0083XA","R220","R4182","Z0101","Z23"],"date":["2024-06-26","2024-06-26","2025-03-17","2024-06-24","2024-11-08","2025-02-19","2025-03-17","2024-07-24","2025-05-29","2024-06-19","2025-03-17","2025-02-14","2025-02-14","2025-02-14","2025-02-14","2023-06-14","2023-06-14","2025-02-26","2025-02-26","2024-10-16","2024-08-21","2024-10-16","2024-07-24","2024-07-24","2023-07-25","2023-12-05","2023-07-18","2024-12-03","2024-07-24","2023-12-05","2023-08-15","2025-01-22","2024-06-26","2024-06-26","2024-06-26","2022-10-21","2022-09-13"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","HALOPERIDOL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","RISPERIDONE","","","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":""}]}]}