{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda A Sawyer","gend":1,"currentgend":"","add":"52 MCFARLAND SHORE RD","city":"NEW HARBOR","state":"ME","zip":"04554","dob":"1949-03-26","age":"","mstatus":"","insh":"10000033241","cliId":"","pno":2076772122,"cno":"","email":"lobtales@tidewater.net","ename":"","eno":"","pphy":"SCOTT, SARAH J","ppno":2075633366,"pcpadd":"Lifespan Family Healthcare,80 River Rd","pcpcity":"Newcastle","pcpstate":"ME","pcpzip":"04553","pcpcounty":"","pcpid":"","pcpname":"LIFESPAN FAMILY HEALTHCARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 457","madd2":"","madd3":"","mcity":"NEW HARBOR","mstate":"ME","mzip":"04554","pcpfaxno":2075634309,"pcpnpi":1497134571,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7DQ4CE7JR93","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25562","M51360","M47817","F32A","M1712","S83412A","S83282A","M25462","Z0100","M62830","S39012A","I951","Z01419","Z90710","Z1231","I10","E039","E785","M5450","Z0000","Z23","U071","M79604","M5431","F418","L03032","L84","M25512","M19012"],"date":["2023-09-14","2025-08-13","2025-08-13","2025-03-25","2023-09-29","2023-09-13","2023-09-23","2023-09-23","2025-03-10","2025-04-04","2025-08-13","2025-06-17","2024-02-08","2024-02-08","2024-01-03","2023-11-16","2023-11-16","2023-11-16","2025-08-13","2023-06-27","2025-10-18","2023-07-08","2025-08-13","2025-08-13","2024-05-15","2024-05-10","2024-07-09","2022-09-19","2022-09-19"],"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":[["","","TIZANIDINE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}