{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Merrillyn Mckee","gend":1,"currentgend":"","add":"18 BEECH ST","city":"Gardiner","state":"ME","zip":"04345","dob":"1947-07-27","age":"","mstatus":"","insh":"10000018182","cliId":"","pno":2075827170,"cno":"","email":"declined@080520.com","ename":"","eno":"","pphy":"HILARY, MANJU","ppno":2076573308,"pcpadd":"126 SHAKER RD,","pcpcity":"GRAY","pcpstate":"ME","pcpzip":"40399629","pcpcounty":"","pcpid":"","pcpname":"GRAY FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 BEECH ST","madd2":"","madd3":"","mcity":"Gardiner","mstate":"ME","mzip":"04345","pcpfaxno":2076573309,"pcpnpi":1710066410,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7RM8QG2GC38","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1142","L84","E1140","E785","I10","E876","F419","K219","M9903","S335XXA","M9904","S336XXA","E1049","Z1231","M79672","M79671","H25812","Z131","H25811","Z1211","R0789","Z23","N3941","D120","M79674","B351","M79675","L570","Z13820","R748","G5761","N6459","D123","D122","M810","Z780","Z0100","E113293","H353132","H25813","M85852","J3489","E119","Z794","D124","N6315","Z0000","R6889"],"date":["2024-08-27","2024-08-27","2025-10-02","2025-07-02","2025-10-02","2024-05-03","2025-07-01","2025-07-01","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2025-11-18","2025-07-08","2023-11-08","2023-11-08","2023-08-31","2023-04-21","2023-08-10","2023-02-07","2024-11-04","2023-09-22","2024-12-23","2023-02-07","2025-07-01","2025-07-01","2025-07-01","2023-02-17","2025-08-06","2025-04-29","2023-06-29","2024-06-06","2023-02-07","2023-02-07","2025-08-06","2025-08-06","2025-01-21","2025-01-21","2025-01-21","2023-08-10","2025-08-06","2025-02-10","2024-11-04","2024-11-04","2023-02-07","2024-06-06","2025-07-01","2022-10-07"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","NOVOLOG MIX 70-30 FLEXPEN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)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":{"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":""}]}]}