{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vanessa A Mcelroy","gend":1,"currentgend":"","add":"472HAMMETT ROAD","city":"WEST ENFIELD","state":"ME","zip":"04493","dob":"1949-05-29","age":"","mstatus":"","insh":"10000033253","cliId":"","pno":2077323980,"cno":"","email":"declined@081122.com","ename":"","eno":"","pphy":"DUHAIME, LAYCEE L","ppno":2077946700,"pcpadd":"PO Box 99,","pcpcity":"Lincoln","pcpstate":"ME","pcpzip":"04457","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2072901948,"add2":"","add3":"","madd1":"P O BOX 193","madd2":"","madd3":"","mcity":"WEST ENFIELD","mstate":"ME","mzip":"04493","pcpfaxno":2077946777,"pcpnpi":1942679899,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9KF4T03FV89","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S299XXA","E1169","M25551","E8342","K760","E118","Z780","E119","I10","E785","D72828","Z1231","Z0101","Z0000","N813","N898","M1712","Z23","R1011","N950","Z1151","Z01419","H2511","M19041","R790","Z124","N939","Z90710","R0782","H43822","R059","M2540","N8003","D251","E1142","Z20822","M8589","M1611","N819","H35363","I4891","M109","H2513","H524","Z1329","H2512","H40013","M79644","J029","R7989"],"date":["2024-06-17","2024-10-22","2023-10-03","2025-03-03","2025-03-03","2025-09-08","2025-09-24","2024-09-03","2025-06-09","2025-03-03","2024-09-18","2023-02-07","2025-02-19","2024-02-14","2023-02-17","2024-10-29","2025-09-08","2023-10-25","2024-09-03","2024-10-29","2022-11-30","2022-11-30","2025-05-15","2025-09-08","2023-08-10","2022-11-30","2024-10-24","2024-10-24","2024-06-17","2025-05-15","2024-08-30","2025-05-08","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2025-09-24","2023-08-16","2023-02-01","2024-02-16","2023-11-16","2024-05-31","2024-02-16","2024-02-16","2025-03-03","2025-05-15","2025-05-15","2025-09-08","2022-10-21","2022-10-05"],"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":[["","","GLIPIZIDE ER","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","DILTIAZEM 12HR ER","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","CARTIA XT","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ULTRA-FINE MICRO PEN NEEDLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","TERCONAZOLE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","PAXLOVID (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":{"indx":[],"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":""}]}]}