{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia A Macarthur","gend":1,"currentgend":"","add":"525 MAIN ST","city":"Princeton","state":"ME","zip":"04668","dob":"1940-11-17","age":"","mstatus":"","insh":"10000024065","cliId":"","pno":2077962320,"cno":"","email":"declined@092524.com","ename":"","eno":"","pphy":"JOHNSON, SALLY","ppno":2077965503,"pcpadd":"136 MILL ST,","pcpcity":"PRINCETON","pcpstate":"ME","pcpzip":"46683344","pcpcounty":"","pcpid":"","pcpname":"ST CROIX REGIONAL FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"525 MAIN ST","madd2":"","madd3":"","mcity":"Princeton","mstate":"ME","mzip":"04668","pcpfaxno":2077965528,"pcpnpi":1457336224,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3UU7K56CT47","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E042","J849","E119","Z7984","H353131","H35342","N289","I10","M0600","M5450","G8929","M353","Z780","H40013","Z0000","M8588","D481","R6889","G4733","R0982","R918","K3189","K2970","E210","M810","Z23","K222","B9681","K2950","Z79899","E1169","K219","R1310","R12","K449","S20211A","H40053","K2960","E213","Z1231","N390","M5136","M47816","Z87442","R300","R1319","R399","Z09","H35363","H35373","H31091"],"date":["2024-10-22","2025-05-07","2025-04-17","2023-06-27","2025-08-18","2023-06-27","2023-11-20","2024-08-13","2025-04-14","2025-04-14","2025-04-14","2023-03-21","2025-08-18","2024-07-31","2025-06-26","2023-07-11","2023-01-30","2023-12-24","2023-02-02","2023-02-02","2023-02-02","2023-01-30","2023-07-29","2024-10-21","2024-10-21","2023-10-18","2023-07-20","2023-07-20","2023-03-21","2023-03-21","2023-10-05","2024-10-09","2022-12-30","2022-12-30","2022-11-11","2025-01-17","2025-02-12","2022-12-30","2023-10-18","2024-08-26","2024-07-16","2023-10-11","2023-10-11","2023-10-16","2023-10-10","2022-11-21","2023-01-06","2024-06-25","2022-08-10","2022-08-10","2022-08-10"],"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":[["","","LATANOPROST","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","PYLERA","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","DAPAGLIFLOZIN","","","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":{"indx":[],"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":""}]}]}