{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sylvia A Farrar","gend":1,"currentgend":"","add":"ST ANDRE 407 POLL ST","city":"Biddeford","state":"ME","zip":"04005","dob":"1944-10-21","age":"","mstatus":"","insh":"10000021197","cliId":"","pno":5124971658,"cno":"","email":"rawillingham@gmail.com","ename":"","eno":"","pphy":"REMILLONG, ELIZABETH L","ppno":6034315154,"pcpadd":"Martins Point Health Care,161 Corporate Dr","pcpcity":"Portsmouth","pcpstate":"NH","pcpzip":"03801","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"315 CATHEDRAL MOUNTAIN PASS","madd2":"","madd3":"","mcity":"Georgetown","mstate":"TX","mzip":"78633","pcpfaxno":6034305033,"pcpnpi":1538253539,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9YQ5YX3VW88","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R456","F0392","E785","G309","S199XXA","R262","F0390","Z87891","S0990XA","N760","B9689","F02818","R531","R918","J439","R109","R4182","S3993XA","Z117","R410","M25571","Z23","Z1231","R404","M79606","Z5320","R2689","N390","E669","R238","S79919A","N898","I10","R462","S8992XA","S79912A","F0280","R451","R296"],"date":["2024-07-24","2024-11-04","2024-02-14","2025-07-01","2024-07-30","2024-06-29","2024-06-29","2024-07-30","2024-07-30","2024-09-16","2024-09-16","2025-07-01","2024-07-30","2024-06-30","2024-06-30","2024-06-30","2024-07-01","2024-07-31","2024-02-14","2024-08-01","2023-05-02","2024-02-14","2023-08-28","2024-06-29","2024-06-29","2025-04-25","2024-08-01","2024-06-30","2023-07-05","2024-08-29","2024-07-30","2024-09-13","2025-04-25","2024-05-15","2024-07-30","2024-07-30","2024-05-15","2024-05-15","2024-07-30"],"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":[["","","MEMANTINE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","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":""}]}]}