{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy King","gend":1,"currentgend":"","add":"1204 EASTBROOK RD","city":"EASTBROOK","state":"ME","zip":"04634","dob":"1947-02-14","age":"","mstatus":"","insh":"10000017315","cliId":"","pno":2075653806,"cno":"","email":"declined@033125.com","ename":"","eno":"","pphy":"HANSON, CASEY S","ppno":2076675899,"pcpadd":"PO BOX 8,","pcpcity":"BAR HARBOR","pcpstate":"ME","pcpzip":"46090008","pcpcounty":"","pcpid":"","pcpname":"TRENTON HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2076649288,"add2":"","add3":"","madd1":"1204 EASTBROOK RD","madd2":"","madd3":"","mcity":"EASTBROOK","mstate":"ME","mzip":"04634","pcpfaxno":2078015123,"pcpnpi":1164536397,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2CX3M62FQ89","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R040","C519","Z08","K7689","K838","K627","Z8544","Z90710","Z9079","Z90722","R920","Z0101","H26493","E119","R921","K625","R0609","I509","R232","G4733","Z1211","D045","R011","Z780","L989","Z0000","K219","D071","G3189","N1330","Z13820","E1122","M19071","I129","C518","Z510","H26492","Z5111","I3139","I517","R109","M25561","K5909","R197","E1136","Z7984","C4492","J9811","J90","N9089","R110","T451X5A","I10","Z923","Z800","Z801","Z0110","D125","K6389","Z452","Z01818","R918","C579","H52203","Z1231"],"date":["2025-01-24","2025-01-08","2025-04-28","2023-07-21","2023-07-21","2024-08-12","2025-04-28","2025-01-08","2025-01-08","2025-01-08","2024-11-15","2024-07-16","2024-07-16","2024-12-05","2023-10-25","2024-07-18","2024-12-17","2024-12-17","2022-12-15","2024-03-25","2023-06-13","2023-06-01","2023-06-19","2023-06-22","2023-06-01","2024-06-05","2025-01-24","2023-06-29","2023-06-26","2024-02-27","2023-06-22","2024-10-25","2024-10-25","2024-10-25","2024-03-13","2023-10-20","2024-09-26","2023-10-06","2024-03-07","2024-03-07","2023-08-18","2025-05-28","2023-08-31","2023-08-31","2023-08-31","2023-08-31","2024-02-27","2024-02-27","2024-02-27","2024-02-27","2024-01-16","2023-08-25","2024-09-06","2023-10-06","2023-10-20","2023-10-20","2023-08-08","2024-08-12","2024-08-12","2023-08-03","2023-08-03","2023-07-26","2023-07-26","2022-09-12","2022-09-07"],"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":[["","","BACLOFEN","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","SILVER SULFADIAZINE","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","BOOSTRIX TDAP","","","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":{"indx":[],"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":""}]}]}