{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy A Moran","gend":1,"currentgend":"","add":"31 CENTRAL ST","city":"Randolph","state":"ME","zip":"04346","dob":"1946-12-27","age":"","mstatus":"","insh":"10000024983","cliId":"","pno":2075825325,"cno":2075925480,"email":"declined@11072025.com","ename":"","eno":"","pphy":"HEATH, WAYNE A","ppno":2075826608,"pcpadd":"Gardiner Family Medicine,5 Central Maine Crossing","pcpcity":"Gardiner","pcpstate":"ME","pcpzip":"43452615","pcpcounty":"","pcpid":"","pcpname":"GARDINER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"31 CENTRAL ST","madd2":"","madd3":"","mcity":"Randolph","mstate":"ME","mzip":"04346","pcpfaxno":2075822258,"pcpnpi":1518489095,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3TY9AD0XF42","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I2510","R079","I340","R519","R5383","I10","U071","E878","G8918","I25118","I700","Z1231","I420","Z9229","N1830","Z01810","Z9049","I4891","M1A3491","I129","M79644","H2511","D649","E538","Z634","I083","I214","Z87891","R92323","J90","Z951","Z98890","E7849","I5022","R2231","M65841","H353131","Z0000","I6523","J9809","I517","I519","Z95811","R918","I5023","I130","J9601","Z20822","R0602","Z853","I429","H2512","E785","H353130","H3554","H5213","I25110","J3489","M154","J45901","Z743","M25571","M19071","T8111XA","H40013","H02841","Z0100","I499","L539","M7989","M79671","Z48812","R059","R0981","R4182","R0989","R509","R931","I361","Z952","I071","N179","M799","J9811","R0600","M1A9XX0","Z79899","R0789","I509","R21","J984","J811"],"date":["2023-04-12","2023-02-23","2023-07-28","2023-02-23","2023-02-23","2023-02-23","2023-03-07","2023-03-07","2023-03-07","2025-08-01","2023-03-27","2025-08-26","2023-07-28","2024-02-07","2023-11-01","2023-02-24","2023-02-24","2025-09-22","2025-01-17","2024-01-30","2024-07-10","2025-09-30","2025-09-05","2024-07-10","2024-07-10","2025-09-26","2023-03-04","2024-04-26","2025-08-26","2023-04-03","2023-04-19","2023-04-19","2024-04-17","2023-05-04","2024-05-10","2024-05-10","2025-10-15","2022-12-16","2023-02-24","2023-02-24","2025-09-22","2023-06-08","2023-06-08","2023-04-08","2023-04-11","2023-04-11","2023-04-08","2023-04-08","2023-04-08","2022-12-16","2023-04-10","2025-10-07","2023-03-01","2025-11-07","2025-11-07","2025-11-07","2023-03-04","2023-02-07","2024-04-29","2023-04-03","2023-02-24","2023-05-31","2023-05-31","2023-03-04","2025-06-11","2025-08-01","2025-03-14","2025-10-06","2024-04-26","2024-04-26","2023-05-31","2023-03-05","2023-02-07","2023-02-07","2023-03-01","2023-04-08","2023-04-08","2023-04-10","2023-04-10","2023-04-10","2025-09-26","2024-01-26","2024-04-26","2023-04-03","2025-09-22","2025-01-29","2025-01-29","2023-02-24","2023-02-24","2025-08-01","2023-03-01","2023-03-01"],"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":[["","","ENTRESTO","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ADVAIR HFA","","","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":""}]}]}