{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Amanda I Donovan","gend":1,"currentgend":"","add":"43 UNION ST","city":"South Berwick","state":"ME","zip":"03908","dob":"1944-03-03","age":"","mstatus":"","insh":"10000026910","cliId":"","pno":6039691340,"cno":"","email":"amandadonovan05@gmail.com","ename":"","eno":"","pphy":"JOKONYA, CHIEDZA","ppno":2073844949,"pcpadd":"789 CENTRAL AVE,","pcpcity":"DOVER","pcpstate":"NH","pcpzip":"38202526","pcpcounty":"","pcpid":"","pcpname":"WHP SOUTH BERWICK FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"43 UNION ST","madd2":"","madd3":"","mcity":"South Berwick","mstate":"ME","mzip":"03908","pcpfaxno":2073845700,"pcpnpi":1043314313,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1M34P48CH88","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G629","I340","J323","M1712","M8008XA","H903","R059","L281","L309","Z01818","H61032","L089","D485","R58","R208","L538","S32020A","J329","J209","Z0000","E785","Z6822","I341","D6851","R29898","M5442","G4730","G8929","R053","K219","R634","H61002","I82452","J069","R052","H401212","H401223","R140","R072","M4856XA","M51369","Z471","Z96652","L570","J90","M7918","M9901","M9909","L2081","L578","L814","S32028A","M5441","R300","X58XXXA","H401211","H5213","H60501","H9201","D689","M5450","L308","Z7189","R1032","R1031","K582","L821","R21","M9908","H6121","Z1231","J3489","M170","Z23","L280","L298","R0781","S32028D","R1310","Z0101","R200","S299XXA","X500XXA","F411","J309","M1711","M47816","R0982","J338","Z8249","R1314","M47812","R0609","Z09","H04123","J342","G8918","K449","D6859","M5417","R202","M549","R5381","J0100","R0981","M7989","H401222","H401132","R413"],"date":["2024-08-05","2025-08-18","2023-12-12","2025-09-17","2025-11-07","2025-08-19","2025-03-28","2024-03-25","2024-03-25","2025-10-28","2023-06-27","2023-07-19","2023-04-17","2023-04-17","2023-04-17","2023-04-17","2025-10-13","2024-02-07","2024-02-07","2023-12-11","2023-12-15","2023-12-11","2025-08-18","2025-08-18","2023-07-06","2024-05-01","2024-05-01","2024-05-01","2024-09-03","2024-09-03","2024-09-03","2023-04-17","2023-11-08","2022-11-28","2025-04-15","2025-11-03","2025-11-03","2023-02-08","2025-01-06","2025-10-23","2025-10-23","2025-09-05","2025-10-07","2025-06-26","2025-03-28","2023-09-01","2023-09-01","2023-09-01","2023-04-17","2023-04-17","2023-04-17","2025-08-30","2025-08-30","2025-08-30","2025-08-30","2023-12-20","2023-04-06","2025-06-22","2025-07-01","2025-08-29","2025-08-29","2025-04-14","2025-04-14","2023-02-08","2022-12-27","2022-12-27","2025-06-26","2023-08-19","2023-09-01","2023-06-13","2025-05-13","2023-06-30","2025-04-15","2022-12-07","2023-09-19","2023-09-19","2023-08-19","2025-10-02","2024-03-11","2024-12-13","2023-08-08","2023-08-19","2023-08-19","2022-12-26","2025-08-19","2025-04-29","2025-08-30","2024-04-29","2023-11-10","2023-01-13","2024-04-29","2023-06-08","2025-01-29","2025-01-29","2025-11-03","2023-11-10","2025-08-21","2024-06-26","2024-05-13","2023-06-14","2023-06-14","2025-08-30","2022-12-07","2024-03-29","2022-10-26","2022-11-14","2022-09-27","2022-06-27","2022-06-22"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CALCITONIN-SALMON","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","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":""}]}]}