{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia H Bickford","gend":1,"currentgend":"","add":"25 LEDGE RIDGE WAY APT 20","city":"ELLSWORTH","state":"ME","zip":"04605","dob":"1947-03-04","age":"","mstatus":"","insh":"10000017375","cliId":"","pno":"","cno":2076645094,"email":"declined@11202023.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":"","add2":"","add3":"","madd1":"25 LEDGE RIDGE WAY APT 20","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2078015123,"pcpnpi":1164536397,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1JE4M22YH80","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","S40262A","M25521","S59901A","M25511","S4991XA","E119","L03818","M48061","R059","N200","K5730","F17200","Z79899","M5416","N390","M519","M7918","G8929","M5450","E6601","Z6834","F17210","R110","M47816","E860","I129","D1801","E1122","N2889","E1165","Z6837","Z5181","M5489","Z13820","G63","M25551","Z0100","E113292","D3132","R112","E1151","R0989","Z794","E1142","M5126","H0014","L500","M79605","M79604","R200","N1832","Z0000","Z7982","M461","R911","B029","G4730","G35","E66813","M160","J439","I2510","R030","P110","N281","N1830","M549"],"date":["2025-03-02","2024-05-24","2025-08-10","2025-08-10","2025-08-10","2025-08-10","2025-09-02","2025-03-13","2025-02-23","2023-09-18","2022-10-18","2022-10-18","2025-03-02","2025-04-09","2024-11-13","2022-10-18","2023-09-26","2023-09-11","2025-04-09","2025-04-09","2025-05-29","2023-06-06","2023-09-08","2022-10-24","2024-12-02","2025-02-12","2024-01-22","2024-01-18","2025-01-31","2024-01-26","2025-02-25","2025-02-25","2024-03-25","2024-10-29","2023-02-28","2022-11-08","2024-11-12","2025-03-24","2025-03-24","2025-03-24","2025-03-03","2022-12-07","2022-12-07","2023-09-25","2022-12-08","2022-10-31","2024-07-02","2025-02-05","2022-12-01","2022-12-01","2022-12-01","2024-01-26","2025-01-22","2023-09-25","2023-11-21","2025-01-29","2024-07-25","2023-05-04","2023-09-26","2025-09-02","2023-06-13","2023-10-18","2024-04-17","2025-04-09","2025-02-26","2022-09-27","2022-09-27","2022-09-26"],"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":[["","","TRADJENTA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","LEVOCETIRIZINE DIHYDROCHLORIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}