{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy E Ryan","gend":1,"currentgend":"","add":"163 MOODY MOUTAIN RD","city":"LINCOLNVILLE","state":"ME","zip":"04849","dob":"1947-10-11","age":"","mstatus":"","insh":"10000019828","cliId":"","pno":2077633152,"cno":"","email":"nryan@tidewater.net","ename":"","eno":"","pphy":"FINLEY, MONICA","ppno":2073386900,"pcpadd":"PO BOX 1599,PENOBSCOT COMMUNITY HEALTH CENTER","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"SEAPORT COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"163 MOODY MOUTAIN RD","madd2":"","madd3":"","mcity":"LINCOLNVILLE","mstate":"ME","mzip":"04849","pcpfaxno":"","pcpnpi":1104176478,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1DT4U94YE86","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C44519","Z85828","D485","L821","C4491","H25812","Z0100","Z0000","C44329","L570","C44712","C4441","C760","C4442","Z961","M2550","H25813","H18513","C44319","R21","I10","Z130","Z13220","R002","Z23","Z1283","C44619","H25013","L858","C44622","L814","X32XXXS","H25811","C44722","L905","C44222","C44729","R0981"],"date":["2023-11-09","2023-11-09","2023-11-09","2023-11-09","2025-01-16","2023-09-11","2024-10-23","2025-06-10","2024-10-17","2025-03-11","2025-01-02","2025-07-07","2025-09-09","2025-10-07","2023-11-08","2025-06-04","2023-05-08","2023-05-08","2024-11-21","2024-02-07","2025-07-16","2025-07-16","2025-07-16","2025-05-29","2023-12-19","2023-10-13","2024-11-14","2023-01-25","2022-12-13","2025-06-23","2023-01-05","2023-01-05","2023-08-14","2022-10-27","2022-08-17","2022-09-06","2022-08-17","2022-07-27"],"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":[["","","MELOXICAM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","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":""}]}]}