{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jerry O Woodman","gend":0,"currentgend":"","add":"54 WILTON RD","city":"FARMINGTON","state":"ME","zip":"04938","dob":"1956-01-01","age":"","mstatus":"","insh":"10000019257","cliId":"","pno":2072150678,"cno":2072150676,"email":"woodyjow@gmail.com","ename":"","eno":"","pphy":"SCHIFF SLATER, SCOTT D","ppno":2076260606,"pcpadd":"Hallowell Family Practice,\t9 Union St","pcpcity":"Hallowell","pcpstate":"ME","pcpzip":"04347","pcpcounty":"","pcpid":"","pcpname":"HALLOWELL FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2072150676,"add2":"","add3":"","madd1":"54 WILTON RD","madd2":"","madd3":"","mcity":"FARMINGTON","mstate":"ME","mzip":"04938","pcpfaxno":2076260022,"pcpnpi":1750354957,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4DG5VH6JN54","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0001","Z125","E119","J449","B354","R198","I2510","I10","Z09","Z872","Z87891","Z0189","E7801","Z7182","Z713","Z0000","Z8551","N139","L309","S62346A","S6291XD","I25110","B358","E7800","C679","E785","K769","R197","R8289","Z0101","N320","L02234","U071","D485","Z08","S62356A","Z951","R030","I700","Z23","L2389","R5383","R6889","S62326D","I77810","I517","I519","S62306A","Z1211","Z1212","I252","R3129","R82998","H524","E7841","N401","N138","D1039","K1379"],"date":["2025-07-01","2023-04-24","2025-06-11","2025-07-28","2023-04-24","2023-11-02","2024-07-30","2025-04-15","2024-06-14","2023-08-03","2025-09-04","2024-01-31","2025-04-15","2025-07-01","2025-07-01","2025-09-25","2025-09-04","2023-01-25","2023-07-31","2024-05-03","2024-06-14","2025-08-22","2023-05-31","2025-01-14","2024-02-02","2023-04-24","2023-05-04","2023-12-07","2025-09-04","2025-01-20","2025-09-04","2023-08-03","2023-01-19","2023-04-24","2025-09-04","2024-03-24","2025-06-03","2025-06-03","2025-06-03","2024-12-11","2022-12-14","2022-12-14","2023-11-29","2024-04-05","2025-06-03","2025-06-03","2025-06-03","2024-03-24","2025-07-09","2025-07-09","2023-12-07","2024-09-05","2024-09-05","2022-11-03","2022-09-14","2022-07-20","2022-07-20","2022-06-07","2022-06-08"],"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":[["","","LEVOCETIRIZINE DIHYDROCHLORIDE","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","RANOLAZINE ER","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","PRALUENT PEN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","HAVRIX","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}