{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ellen S Broas","gend":1,"currentgend":"","add":"126 PLEASANT ST","city":"Auburn","state":"ME","zip":"04210","dob":"1953-10-08","age":"","mstatus":"","insh":"10000026305","cliId":"","pno":2074403194,"cno":2074403194,"email":"","ename":"","eno":"","pphy":"RABY, NATHAN C","ppno":2079982100,"pcpadd":"Community Health Center,364 Maine St","pcpcity":"Poland","pcpstate":"ME","pcpzip":"04274","pcpcounty":"","pcpid":"","pcpname":"POLAND COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"126 PLEASANT ST","madd2":"","madd3":"","mcity":"Auburn","mstate":"ME","mzip":"04210","pcpfaxno":"","pcpnpi":1770528143,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5KU1PN3KM03","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C44329","C44320","C770","D164","Z01818","M7500","I10","H401231","Z515","J8410","D649","R221","R531","L905","L97511","L97521","Z853","Z1231","C801","Z0000","L4059","L404","D487","Z1283","L858","L570","Z4682","D509","L4052","R4182","R918","M75101","R6889","E8342","Z5189","H353130","R1110","I82C11","M216X1","M216X2","M79671","J84112","A4101","L910","A419","E43","J159","J690","J384","Z85828","M19011","K1233","R234","Z510","B358","L7622","D2330","J189","Z930","I82890","D696","C779","C07","L602","L601","B354","M25511","Z79899","R0600","Z7982","K8020","K9423","M7989","R229","Z8589","K921","J849","J9801","E876","Z5111","Z452","Z6831","R21","R7881","E7800","M79672","M2041","S72142D","R042","C44321","L600","L603","C4492","Z945","K828","R053","M25571","M25572","M19071","M779","M21621","Z09","Z862","R52","L03115","M25552","W1849XA","S72002A","S72142A","S72122A","Z98890","W1830XA","Y92009","Z20822","Z7952","D638","Z9229"],"date":["2025-09-02","2025-10-14","2025-09-02","2025-05-05","2025-01-20","2025-02-18","2025-09-02","2025-06-16","2025-10-06","2025-10-21","2025-10-06","2025-09-03","2025-09-02","2024-08-21","2024-10-08","2025-07-29","2025-09-02","2024-09-17","2025-09-30","2025-03-17","2025-02-12","2025-02-12","2024-02-05","2024-05-24","2024-05-24","2024-09-10","2025-09-04","2025-09-02","2023-03-14","2025-11-06","2025-09-21","2025-01-13","2023-08-18","2025-08-28","2025-08-14","2024-12-21","2025-10-02","2025-11-06","2023-03-14","2023-03-14","2024-03-26","2024-05-17","2025-11-02","2024-08-21","2025-11-02","2025-09-09","2025-09-09","2025-09-09","2025-09-09","2024-03-27","2024-10-14","2025-08-25","2025-08-25","2025-08-25","2024-09-10","2024-03-07","2024-09-10","2025-10-17","2025-10-17","2025-10-01","2025-10-01","2025-05-05","2025-05-05","2024-01-02","2024-01-02","2024-10-08","2024-10-09","2024-10-09","2024-11-22","2024-03-07","2025-10-16","2025-10-16","2025-10-19","2025-02-18","2025-02-18","2025-10-02","2024-11-22","2023-02-09","2025-08-27","2025-08-05","2025-11-10","2023-03-09","2024-09-10","2025-11-10","2025-04-05","2022-11-26","2022-11-26","2022-11-10","2025-10-01","2025-02-27","2023-12-19","2024-01-02","2025-05-05","2024-08-06","2025-10-23","2023-09-27","2022-11-10","2022-11-10","2022-11-15","2022-11-15","2022-11-17","2022-11-03","2022-11-03","2022-10-12","2022-09-22","2022-08-07","2022-08-07","2022-08-11","2022-08-12","2022-08-07","2022-08-26","2022-08-07","2022-08-07","2022-08-07","2022-08-07","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":[["","","TRAVOPROST","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","VALSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TRIMETHOPRIM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","SILVER SULFADIAZINE","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","LEFLUNOMIDE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","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":""}]}]}