{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Julia A Kirkpatrick","gend":1,"currentgend":"","add":"100 CONY RD","city":"AUGUSTA","state":"ME","zip":"04330","dob":"1948-12-14","age":"","mstatus":"","insh":"10000032226","cliId":"","pno":2076231386,"cno":"","email":"jkirkgkirk@aol.com","ename":"","eno":"","pphy":"BEALL, JORDAN S","ppno":2079737979,"pcpadd":"EMMC Family Medicine Center and Residency,895 Union St Ste 12","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"AUGUSTA FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"100 CONY RD","madd2":"","madd3":"","mcity":"AUGUSTA","mstate":"ME","mzip":"04330","pcpfaxno":2079479579,"pcpnpi":1689197469,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1UH7C45QE48","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R1031","Z1231","L97129","L97119","K56699","R531","M40209","G35","R482","Z7969","M79641","M1811","G3189","M85859","Z780","K5730","K5732","K760","K449","K8020","E8352","K1120","E559","B351","M79631","L089","L89890","E860","R935","I10","Z87891","Z0100","Z0000","Z0001","R195","R2689","R000","R609","Z79899","G9341","R9082","R9089","M109","M7989","R5381","M79672","M5030","M47812","G319","K529","L89899","M19041","R413","G8929","M4712","M50021","M5003","M4802","R930","M25562","M25462"],"date":["2023-06-08","2024-11-05","2025-06-18","2025-06-18","2024-03-28","2025-05-26","2025-05-26","2025-09-11","2025-07-23","2025-07-23","2024-12-31","2024-11-19","2025-02-05","2024-11-05","2024-11-05","2024-05-15","2023-10-11","2023-07-28","2023-07-28","2023-07-28","2024-06-07","2025-06-25","2024-10-01","2025-09-11","2024-12-31","2023-03-16","2025-06-04","2025-05-26","2023-06-08","2025-06-09","2025-04-10","2025-09-09","2025-04-10","2023-09-14","2023-09-14","2023-09-14","2025-05-25","2025-05-25","2024-09-04","2025-05-26","2025-05-26","2024-11-09","2025-06-10","2025-06-10","2025-06-10","2025-06-10","2025-05-26","2025-05-26","2025-05-26","2023-06-08","2025-06-11","2024-05-15","2022-11-09","2022-11-16","2022-10-22","2022-10-22","2022-10-22","2022-10-22","2022-10-22","2022-11-16","2022-11-16"],"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":[["","","BACLOFEN","","","Select","Select",""],["","","KESIMPTA PEN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DIMETHYL FUMARATE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","VUMERITY","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}