{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Amy B Gillis","gend":1,"currentgend":"","add":"261 STATE HIGHWAY 3","city":"Bar Harbor","state":"ME","zip":"04609","dob":"1968-03-06","age":"","mstatus":"","insh":"10000032248","cliId":"","pno":2075071098,"cno":2074602153,"email":"eclined@111324.com","ename":"","eno":"","pphy":"BENNETT, BRITTANY A","ppno":2078242193,"pcpadd":"Bethel Family Health Center,32 Railroad St","pcpcity":"Bethel","pcpstate":"ME","pcpzip":"04217","pcpcounty":"","pcpid":"","pcpname":"BETHEL FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 327","madd2":"","madd3":"","mcity":"Hulls Cove","mstate":"ME","mzip":"04644","pcpfaxno":"","pcpnpi":1083227664,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6JF9JN8KY22","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M542","F4312","H5203","H52223","H524","Z1501","I10","Z48810","Z01419","Z1231","G4731","E215","M9903","M9904","S336XXA","M9902","F4320","Z803","F449","H2512","H11043","H5211","R921","H25011","M19011","H52212","R6889","N6322","Z113","R92323","Z0000","M5136","N6320","E213","M79671","F319","G4733","G608","M47812"],"date":["2024-11-20","2023-11-03","2023-10-12","2024-07-22","2023-10-12","2025-01-05","2025-09-03","2024-06-24","2024-08-28","2025-08-27","2025-02-03","2024-11-21","2023-11-06","2023-11-06","2023-11-06","2023-10-19","2025-06-17","2025-08-27","2025-09-02","2024-06-06","2024-07-22","2024-07-22","2024-07-30","2024-05-23","2024-11-22","2023-11-15","2022-07-09","2024-07-30","2024-07-24","2025-01-05","2024-08-28","2023-11-06","2024-07-30","2023-03-24","2025-09-12","2023-03-24","2023-03-24","2024-07-23","2024-11-20"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","AZITHROMYCIN","","","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":{"indx":[["","","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}