{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna L Hathorne","gend":1,"currentgend":"","add":"471 POTTLE HILL RD","city":"Minot","state":"ME","zip":"04258","dob":"1948-04-21","age":"","mstatus":"","insh":"10000025735","cliId":"","pno":2073459593,"cno":"","email":"declined@011725.com","ename":"","eno":"","pphy":"GOODMAN, MARGO B","ppno":2077952800,"pcpadd":"789 MINOT AVE,","pcpcity":"AUBURN","pcpstate":"ME","pcpzip":"42103924","pcpcounty":"","pcpid":"","pcpname":"CMMC FAMILY MEDICINE RESIDENCY PROGRAM","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"471 POTTLE HILL RD","madd2":"","madd3":"","mcity":"Minot","mstate":"ME","mzip":"04258","pcpfaxno":2077958490,"pcpnpi":1912268764,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7FA3GC4RY60","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S72001D","D509","R6889","Z98890","Z0000","R42","J449","I6529","Z1231","Z96649","R233","M62838","I872","H2511","Z23","H04123","Z1211","D125","I517","I493","E611","R000","I447","Z87891","S72001A","M8589","Z96641","Z471","Z136","Z86010","D123","D120","K5730","R21","Z780","S7001XA","Z860100","S5001XA","V180XXA","Y9355","E785","H2512","I6523","I6522","D175","I6521","H1045","Z961","H524","H52223","M85852","H2513"],"date":["2023-08-28","2025-07-16","2023-06-28","2024-05-20","2023-03-01","2023-03-01","2025-07-21","2024-04-18","2025-02-08","2023-10-12","2025-02-18","2025-02-18","2025-02-18","2023-01-03","2023-10-11","2024-02-01","2025-01-03","2025-01-03","2022-12-09","2022-12-09","2025-07-21","2023-08-24","2023-08-25","2024-07-09","2023-08-28","2025-06-10","2024-05-20","2023-08-26","2024-04-18","2023-11-17","2023-11-17","2023-11-17","2025-01-03","2023-07-11","2025-06-10","2023-08-25","2025-01-03","2023-08-24","2023-08-24","2023-08-24","2023-08-24","2022-12-20","2023-04-11","2023-04-11","2023-06-21","2024-04-18","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2023-04-11","2022-11-10"],"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":[["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","VENTOLIN HFA","","","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":""}]}]}