{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth Hook","gend":1,"currentgend":"","add":"96 ELM ST","city":"NEWPORT","state":"ME","zip":"04953","dob":"1942-09-23","age":"","mstatus":"","insh":"10000020775","cliId":"","pno":2074168318,"cno":2074168318,"email":"hook4320@roadrunner.com","ename":"","eno":"","pphy":"NKENG, YANNICK N","ppno":2076687755,"pcpadd":"Jackman Community Health Center,376 Main St","pcpcity":"Jackman","pcpstate":"ME","pcpzip":"04945","pcpcounty":"","pcpid":"","pcpname":"JACKMAN COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"96 ELM ST","madd2":"","madd3":"","mcity":"NEWPORT","mstate":"ME","mzip":"04953","pcpfaxno":2076687605,"pcpnpi":1336679380,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7VA8WW1AY67","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D509","F330","Z0000","Z01812","M069","M25562","M1712","Z471","G5701","M160","Z13820","I776","M25511","S43011A","R3915","M12811","E039","R634","I6782","J069","Z01810","M3500","I082","D649","I491","I447","I3139","R6889","Z0100","R059","R053","M25551","M779","M5135","M47816","M4316","M5136","Z0001","Z961","H5213","Z79899","H04123","H02881","H02886","Z96652","M154","M1990","R931","F419","Z01818","M19011","R0789","M7912","M8580","M25561","M170","R4189","Z87891","Z780","N939","Z1151","Z01419","Z23","Z96651"],"date":["2025-04-24","2024-07-03","2024-05-30","2025-10-01","2024-01-29","2024-11-14","2025-05-07","2025-08-29","2023-03-01","2023-03-27","2023-04-27","2024-01-29","2024-10-02","2025-05-27","2023-07-18","2025-04-09","2022-12-05","2025-07-02","2025-07-07","2024-09-27","2025-10-01","2025-10-06","2025-02-20","2025-07-03","2025-05-07","2025-05-07","2025-06-17","2023-01-24","2025-09-09","2024-12-17","2024-11-14","2023-03-27","2023-03-27","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2025-06-03","2024-07-02","2024-07-02","2025-09-18","2023-07-10","2023-07-10","2023-07-10","2025-08-29","2023-02-01","2025-10-01","2023-07-05","2022-11-30","2025-05-27","2025-05-27","2023-06-06","2025-09-24","2023-12-21","2023-03-30","2023-03-22","2025-11-13","2025-11-13","2023-04-27","2022-10-12","2022-10-11","2022-10-11","2022-10-11","2022-07-26"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","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":""}]}]}