{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joanne E Reynolds","gend":1,"currentgend":"","add":"22 SERENITY WAY","city":"Bridgton","state":"ME","zip":"04009","dob":"1944-03-26","age":"","mstatus":"","insh":"10000025545","cliId":"","pno":2076473012,"cno":"","email":"declined@090123.com","ename":"","eno":"","pphy":"RIVARD, GARY S","ppno":2075243501,"pcpadd":"180 CHURCH HILL RD,STE 1","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 144","madd2":"","madd3":"","mcity":"North Bridgton","mstate":"ME","mzip":"04057","pcpfaxno":2076476015,"pcpnpi":1194801993,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1C63EG6HJ11","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L900","N9089","M79671","M25511","B070","I2510","N762","N390","S93409A","M79601","M25571","M5412","J9811","I96","M5450","M19011","N3000","R230","M4722","Z23","Z0130","M75101","M19071","R600","M75121","S43421D","M4802","M50122","M4312","Z01812","R300","S92211A","E785","M7671","S46011A","S93401A","M4316","M7061","M48061","M7062","I10","R238","M7750","S43421A","E538","Z0101","R058","M47812","M50322","M25551","M47816"],"date":["2025-03-14","2025-11-11","2025-10-07","2024-05-02","2025-06-16","2025-11-14","2025-05-06","2023-07-31","2025-04-22","2025-03-04","2025-08-18","2025-02-27","2023-07-31","2024-02-20","2023-06-28","2024-11-22","2023-08-08","2023-02-07","2025-02-27","2023-10-17","2023-02-15","2023-10-17","2025-10-07","2025-07-10","2024-01-04","2024-07-18","2025-02-27","2025-02-27","2025-02-27","2024-02-13","2023-07-27","2025-07-23","2025-11-14","2025-07-10","2024-02-20","2025-04-22","2023-05-17","2023-05-17","2023-05-17","2023-05-17","2025-11-14","2025-05-06","2025-05-27","2024-01-22","2025-03-11","2025-05-21","2022-11-23","2022-10-25","2022-10-25","2022-10-12","2022-10-12"],"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":[["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","REPATHA SYRINGE","","","Select","Select",""],["","","EUTHYROX","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PRALUENT PEN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","REPATHA PUSHTRONEX","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}