{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Judith Y Willis","gend":1,"currentgend":"","add":"79A MILLER ST","city":"BELFAST","state":"ME","zip":"04915","dob":"1940-10-11","age":"","mstatus":"","insh":"10000033304","cliId":"","pno":5185881119,"cno":"","email":"ajwillis75@yahoo.com","ename":"","eno":"","pphy":"FINLEY, MONICA","ppno":2073386900,"pcpadd":"PO BOX 1599,PENOBSCOT COMMUNITY HEALTH CENTER","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"SEAPORT COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"79A MILLER ST","madd2":"","madd3":"","mcity":"BELFAST","mstate":"ME","mzip":"04915","pcpfaxno":"","pcpnpi":1104176478,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9UY4NT7EP09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","H26493","H35371","H353130","H18513","Z1283","E538","D649","K922","H26492","H353132","M5416","Z7952","M353","Z1231","Z0101","Z961","N3000","H353131","H348322","H26491","U071","K921","I2109","Z23","D62","S50862A","K449","L818","I2510","I110","I255","E785","R918","R079","N1831","M810","R69","M160","I213","M25551","M6740","L821","I781","L570","H6121","D500","K2950","I10","H18503","M47816","M8588","Z780","Z743","I252","I2102","L820","L219","D1801","Z13820","I4720","I5022","N390","I5020","R6889","H2511","K219","H2512"],"date":["2024-11-21","2024-08-30","2024-06-26","2024-06-26","2024-06-26","2025-08-13","2024-10-15","2024-10-15","2024-10-15","2024-10-21","2025-11-06","2024-11-11","2025-04-24","2025-05-16","2025-01-24","2025-11-06","2025-11-06","2025-02-21","2024-08-30","2024-08-30","2024-09-20","2024-12-27","2023-01-06","2024-01-03","2023-07-12","2023-05-10","2023-07-17","2023-01-06","2024-01-10","2024-06-14","2023-05-24","2024-06-14","2024-06-14","2022-12-26","2022-12-26","2024-06-04","2024-06-04","2023-01-06","2024-03-28","2023-07-07","2024-05-24","2022-12-20","2022-12-20","2022-12-20","2024-01-16","2023-06-24","2023-01-25","2023-01-06","2024-06-14","2023-07-19","2024-02-15","2023-09-07","2023-09-07","2022-12-26","2023-01-25","2022-12-30","2024-01-16","2024-01-16","2024-01-16","2023-09-07","2022-12-30","2022-12-30","2022-12-30","2023-03-09","2022-09-28","2022-08-15","2022-08-15","2022-07-25"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","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":""}]}]}