{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gloria J Grafflin","gend":1,"currentgend":"","add":"16 HOULTON RD","city":"DANFORTH","state":"ME","zip":"04424","dob":"1942-03-06","age":"","mstatus":"","insh":"10000020658","cliId":"","pno":2074482230,"cno":"","email":"declined@11252024.com","ename":"","eno":"","pphy":"MCIVER, LYNDSAY","ppno":2074482347,"pcpadd":"East Grand Health Center,201 Houlton Rd","pcpcity":"Danforth","pcpstate":"ME","pcpzip":"04424","pcpcounty":"","pcpid":"","pcpname":"EAST GRAND HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 372","madd2":"","madd3":"","mcity":"Danforth","mstate":"ME","mzip":"04424","pcpfaxno":2074482313,"pcpnpi":1205447067,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7MD5KJ0XG75","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E041","N390","E079","H04123","R413","Z0000","Z1231","R0982","H524","E119","E785","R5383","E042","E049","Z8639","Z0101","H43811","U071","T148XXA","R42","Z743"],"date":["2025-05-21","2025-08-26","2025-07-28","2025-06-11","2025-09-04","2025-06-25","2024-04-25","2024-01-03","2025-06-11","2024-02-06","2024-02-06","2024-02-06","2025-05-21","2025-05-21","2025-05-21","2024-02-26","2024-02-26","2024-02-15","2025-08-26","2025-08-28","2025-08-26"],"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":[["","","AUTOLET IMPRESSION","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","TRUE METRIX GO","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PAXLOVID","","","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":""}]}]}