{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Helen E Howard","gend":1,"currentgend":"","add":"119 CENTRAL ST","city":"Hallowell","state":"ME","zip":"04347","dob":"1949-04-01","age":"","mstatus":"","insh":"10000033418","cliId":"","pno":2074584475,"cno":"","email":"lovemate@roadrunner.com","ename":"","eno":"","pphy":"WHITE TRASK, MONICA J","ppno":2072136713,"pcpadd":"219 CAPITOL ST 5,","pcpcity":"AUGUSTA","pcpstate":"ME","pcpzip":"43306237","pcpcounty":"","pcpid":"","pcpname":"FAMILY FOCUSED HEALTHCARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"119 CENTRAL ST","madd2":"","madd3":"","mcity":"Hallowell","mstate":"ME","mzip":"04347","pcpfaxno":2072136785,"pcpnpi":1740522648,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3K80T88HU02","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R1031","D509","K5730","K5700","Z9884","M1711","R0609","L0390","G4733","N949","C4441","F339","R002","Z0101","M2550","Z9989","M79604","I080","R0600","I771","C44319","Z8249","I77810","M9901","M542","M9902","M9903","E039","Z13820","R109","Z9049","K449","N281","K862","K529","D649","L500","R6881","L821","L988","L308","Z08","D485","R6889","Z7189","M25561","F429","F4320","R2241","Z713","Z0000","J4520","G43909","F419","I10","M797","K4090","R1032","K5792","L570","R739","M7989","Z79899","T148XXA","K219","Z1231","I4710","I491","R5383","M85859","M79605","B372","E611","D169","R600","G44209","M25471","M25472","G4731","G4710","I809","M25572","M79672"],"date":["2024-12-27","2025-06-30","2025-02-20","2025-02-20","2025-06-30","2023-09-22","2024-02-26","2024-05-31","2024-04-26","2023-04-27","2023-04-27","2023-10-04","2025-03-11","2025-07-09","2025-06-12","2023-10-25","2023-05-15","2024-03-08","2024-03-15","2023-10-25","2023-04-20","2024-03-15","2024-03-08","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2024-02-28","2025-09-22","2024-12-30","2024-12-30","2024-12-30","2024-12-30","2024-12-30","2024-12-30","2024-12-30","2024-04-26","2024-04-26","2023-02-20","2023-02-20","2023-02-20","2023-02-20","2023-02-20","2023-12-23","2025-04-28","2023-09-22","2023-04-17","2023-04-17","2023-05-15","2024-07-12","2023-10-04","2023-10-04","2023-10-04","2023-10-04","2025-06-30","2023-10-04","2025-05-05","2024-12-30","2024-12-30","2023-02-20","2025-09-18","2025-05-05","2025-06-30","2024-12-10","2024-12-10","2023-02-22","2025-03-12","2025-03-12","2025-06-30","2025-09-22","2022-11-29","2022-11-29","2025-09-11","2023-09-22","2023-11-30","2025-06-12","2025-06-12","2025-06-12","2022-11-11","2022-11-11","2022-09-27","2022-08-16","2022-08-16"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","VILAZODONE HCL","","","Select","Select",""],["","","TRINTELLIX","","","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":""}]}]}