{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Helga A Cross","gend":1,"currentgend":"","add":"175 MAIN ST","city":"MILFORD","state":"ME","zip":"04461","dob":"1938-02-22","age":"","mstatus":"","insh":"10000024404","cliId":"","pno":2078274756,"cno":"","email":"noemail@noemail.com","ename":"","eno":"","pphy":"ROBERTS, CHARLES A","ppno":2078276128,"pcpadd":"PO Box 1599,","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04402","pcpcounty":"","pcpid":"","pcpname":"HELEN HUNT HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 295","madd2":"","madd3":"","mcity":"MILFORD","mstate":"ME","mzip":"04461","pcpfaxno":2078276605,"pcpnpi":1295884716,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1P92RV6FH14","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5459","M25552","R6889","N1830","Z789","R531","M549","B351","M79675","M79674","H6092","M5450","M439","W19XXXA","Y939","E785","D649","G510","R739","I10","S3992XA","S79912A","N1832","R5383","F0390","N289"],"date":["2023-05-26","2023-05-23","2023-05-24","2023-12-11","2023-05-24","2023-05-24","2023-05-24","2023-03-29","2023-03-29","2023-03-29","2024-07-24","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2023-03-16","2023-12-19","2025-03-31","2023-03-16","2023-12-19","2023-05-23","2023-05-23","2023-12-19","2023-12-19","2024-11-19","2022-11-03"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}