{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Merilyn L Brunton","gend":1,"currentgend":"","add":"28 PLEASANT ST APT 5","city":"RANGELEY","state":"ME","zip":"04970","dob":"1944-04-23","age":"","mstatus":"","insh":"10000031776","cliId":"","pno":2078643970,"cno":2076708156,"email":"merilynbrunton@gmail.com","ename":"","eno":"","pphy":"ZAVOTSKY, DIANE","ppno":2076724187,"pcpadd":"Bingham Area Health Center,237 Main St","pcpcity":"Bingham","pcpstate":"ME","pcpzip":"00000","pcpcounty":"","pcpid":"","pcpname":"RANGELEY FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 PLEASANT ST APT 5","madd2":"","madd3":"","mcity":"RANGELEY","mstate":"ME","mzip":"04970","pcpfaxno":2076723641,"pcpnpi":1023128261,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7P37KX5XH68","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1321","E7800","G20B2","R399","T148XXA","R531","R55","G20C","R600","R0682","R52","Z515","R262","R2689","S7011XD","K0530","F419","Z79899","Z0101","R110","R251","E871","R7989","S80812A","Z1231","K5901","G20A1","L570","G20","Z23","H52229","S8011XD","M79604","R2241","R300","R9089","S8011XA","R112","S79821A","I959","K5730","M5450","I700","Z1329","Z13820","E782","M1611","R197","T782XXA","M85852","K5900","S7011XA","R1110","R011","Z9181"],"date":["2023-03-21","2023-03-21","2024-09-06","2023-05-31","2025-08-04","2025-08-09","2023-05-25","2025-08-21","2024-06-18","2025-09-13","2025-09-13","2025-09-20","2025-08-20","2025-08-20","2025-08-20","2024-07-23","2025-09-20","2025-09-20","2025-04-10","2025-08-03","2023-12-08","2025-08-03","2025-08-03","2022-12-09","2025-04-10","2024-12-26","2023-11-09","2023-11-21","2023-05-25","2022-12-01","2023-01-10","2025-07-24","2025-07-26","2025-07-10","2023-03-21","2024-09-06","2025-07-26","2023-05-25","2025-07-28","2025-08-08","2024-03-03","2024-03-03","2024-03-03","2023-12-08","2023-12-08","2023-12-08","2025-07-26","2025-08-04","2023-05-25","2025-04-10","2024-03-03","2025-07-26","2025-08-24","2024-06-18","2024-07-01"],"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":[["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","MORPHINE SULFATE","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","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":""}]}]}