{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pauline C Desanctis","gend":1,"currentgend":"","add":"94 EIGHTH ST","city":"AUBURN","state":"ME","zip":"04210","dob":"1947-04-29","age":"","mstatus":"","insh":"10000019427","cliId":"","pno":2077825344,"cno":2074009330,"email":"","ename":"","eno":"","pphy":"SKELTON, SARAH K","ppno":2077847388,"pcpadd":"Family Health Care Associates,190 Stetson Rd","pcpcity":"Auburn","pcpstate":"ME","pcpzip":"04210","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"94 EIGHTH ST","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":2077952043,"pcpnpi":1861489882,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7PP5TK7HV66","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C44311","R059","K5900","B029","Z0000","Z23","J029","Z0101","H16223","L989","R5383","U071","E785","R7989","F329","Z85828","R634","R0602","Z1231","Z0001","F419","N289","K5641","F325","M5450","J329","F3342","E559"],"date":["2024-07-29","2024-03-12","2025-10-20","2025-10-20","2025-08-12","2023-12-08","2023-09-29","2025-03-25","2025-03-25","2023-06-20","2023-09-29","2023-09-29","2024-04-12","2024-11-19","2025-05-14","2023-08-02","2024-04-12","2024-05-02","2025-11-10","2024-08-05","2024-11-12","2024-11-19","2025-10-20","2024-09-10","2024-09-10","2023-11-17","2022-11-16","2022-11-16"],"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":[["","","FAMOTIDINE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FAMCICLOVIR","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OXYCODONE HCL","","","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":[]}},{"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":""}]}]}