{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ruth A Peters","gend":1,"currentgend":"","add":"196 STETSON RD","city":"AUBURN","state":"ME","zip":"04210","dob":"1943-04-15","age":"","mstatus":"","insh":"10000031755","cliId":"","pno":2074234952,"cno":"","email":"flwrgrl319@hotmail.com","ename":"","eno":"","pphy":"LOWMAN, SCOTT","ppno":"","pcpadd":"15 E CHESTNUT ST,","pcpcity":"AUGUSTA","pcpstate":"ME","pcpzip":"43305736","pcpcounty":"","pcpid":"","pcpname":"MINOT AVENUE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"42 CHESTNUT DR","madd2":"","madd3":"","mcity":"TURNER","mstate":"ME","mzip":"04282","pcpfaxno":2076261849,"pcpnpi":1588070593,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7H78QQ8UD47","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R319","R269","R296","F03911","R300","F0390","L600","M79674","M79675","Z780","Z0101","R2689","S20212A","N3091","S2242XA","G309","R4182","R45850","D329","N1831","Z79899","Z7982","S79911A","D649","M1711","S0990XA","S199XXA","M79605","W19XXXA","G4709","R011","Z09","S40812A","E782","B351","K922","R1084","K649"],"date":["2023-08-22","2024-03-05","2024-03-05","2024-11-01","2023-08-22","2025-03-12","2025-07-25","2025-07-25","2025-07-25","2025-04-02","2024-08-20","2024-08-09","2024-04-08","2023-09-01","2024-04-08","2023-10-19","2023-11-11","2023-11-11","2025-03-12","2025-03-12","2023-11-11","2023-11-11","2025-05-09","2023-03-21","2025-05-09","2025-05-09","2025-05-09","2025-05-09","2025-05-09","2024-02-15","2024-02-15","2023-12-29","2024-04-08","2024-08-09","2022-11-04","2022-09-14","2022-09-14","2022-09-14"],"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":[["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","REXULTI","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","HAVRIX","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","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":""}]}]}