{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda D Gravitt","gend":1,"currentgend":"","add":"3 TASKER LN","city":"Berwick","state":"ME","zip":"03901","dob":"1947-03-22","age":"","mstatus":"","insh":"10000023178","cliId":"","pno":6037813242,"cno":"","email":"LINDAGRAVITT1947@GMAIL.COM","ename":"","eno":"","pphy":"DIEDERICHS, KATRINA L","ppno":6036096800,"pcpadd":"789 CENTRAL AVE,","pcpcity":"DOVER","pcpstate":"NH","pcpzip":"38202526","pcpcounty":"","pcpid":"","pcpname":"WHP INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 TASKER LN","madd2":"","madd3":"","mcity":"Berwick","mstate":"ME","mzip":"03901","pcpfaxno":"","pcpnpi":1821023607,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3VT8N81HN23","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K130","K140","N3946","K219","M1990","N3941","R6889","I679","K257","I4820","I10","H2512","F418","H25812","D500","H2511","I4891","Z23","H25811","Z9884","Z8711","Z9181","M542","H25813","H43812","N23","R1032","N132","R1031","M9901","G4486","N951","E559","Z7901","I739","H2513","H5203","H52223","H524","R413","R634","R109"],"date":["2023-09-22","2023-09-22","2025-08-11","2025-07-12","2025-07-12","2025-08-18","2022-12-07","2023-08-29","2023-08-29","2023-08-29","2023-08-29","2023-10-04","2023-10-04","2023-10-04","2025-07-09","2023-12-18","2023-12-18","2024-12-04","2023-12-18","2025-07-09","2025-07-09","2025-07-09","2023-05-02","2023-07-27","2023-07-27","2024-10-09","2024-10-09","2024-10-09","2024-10-09","2022-12-19","2024-06-17","2023-02-28","2023-02-28","2023-02-14","2024-05-18","2022-12-07","2022-12-07","2022-12-07","2022-12-07","2022-11-08","2022-11-08","2022-07-20"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","DABIGATRAN ETEXILATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","PRADAXA","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","KLOR-CON M10","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","LAMOTRIGINE","","","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":""}]}]}