{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charlotte C Salata","gend":1,"currentgend":"","add":"49 DENNETT RD","city":"North Berwick","state":"ME","zip":"03906","dob":"1947-09-29","age":"","mstatus":"","insh":"10000019485","cliId":"","pno":2074596767,"cno":"","email":"CHARL.SALATA09@GMAIL.COM","ename":"","eno":"","pphy":"NEAL, ELIZABETH","ppno":2078731036,"pcpadd":"York Family Practice,127 Long Sands Rd Ste 11","pcpcity":"York","pcpstate":"ME","pcpzip":"03909","pcpcounty":"","pcpid":"","pcpname":"YORK FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"49 DENNETT RD","madd2":"","madd3":"","mcity":"North Berwick","mstate":"ME","mzip":"03906","pcpfaxno":5122671726,"pcpnpi":1356455265,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8Q01KU5GX07","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I70203","R5382","R197","Z1231","L602","M25562","R002","R6889","M9903","M5116","M9901","M62830","M5450","K8020","H00022","K5730","K52831","H16011","H16231","M7910","H349","G3184","M79604","M546","M9902","M25512","M542","R140","K580","R634","H35362","H25012","H40051","I4719","M9904","H3411","R1013","R1011","M810","H52222","K449","E7800","K219","H409","D6489","Z0101","E079","Z0000","R1084","I7091","Z1329","K6389","R195","R1030","K838","K760","L814","L821","L308","L84","R194","K52839","G609","M9905","M1712"],"date":["2025-10-14","2024-10-04","2024-11-25","2025-10-02","2024-10-01","2025-07-23","2025-01-23","2023-12-14","2025-10-20","2025-10-20","2025-10-20","2025-10-20","2025-04-14","2023-09-12","2022-12-08","2023-10-25","2023-12-12","2025-06-23","2025-11-05","2024-10-08","2023-11-21","2025-11-04","2025-11-04","2025-04-14","2025-04-07","2023-03-02","2025-03-31","2024-05-23","2024-05-23","2025-05-05","2023-01-12","2023-02-09","2022-12-16","2025-04-03","2024-11-11","2025-09-24","2024-03-22","2023-09-11","2025-03-11","2023-02-09","2025-05-05","2024-06-28","2025-05-05","2025-05-05","2023-09-26","2025-11-05","2023-10-11","2023-11-29","2025-05-05","2023-08-08","2023-05-16","2023-10-25","2024-08-19","2023-09-12","2023-09-12","2023-09-12","2024-09-05","2024-09-05","2024-09-05","2024-09-05","2023-09-26","2025-09-16","2023-07-25","2025-03-03","2022-06-14"],"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":[["","","COLESTIPOL HCL","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","SODIUM CHLORIDE","","","Select","Select",""],["","","VANCOMYCIN HCL","","","Select","Select",""],["","","KAPSPARGO SPRINKLE","","","Select","Select",""],["","","LOTEPREDNOL ETABONATE","","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","BUDESONIDE EC","","","Select","Select",""],["","","BUDESONIDE DR","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","DICYCLOMINE HCL","","","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":""}]}]}