{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra E Ames","gend":1,"currentgend":"","add":"10 TEN LOTS RD","city":"OAKLAND","state":"ME","zip":"04963","dob":"1949-08-31","age":"","mstatus":"","insh":"10000034471","cliId":"","pno":2074653094,"cno":"","email":"sndrames@gmail.com","ename":"","eno":"","pphy":"LASH RADIC, AIMEE E","ppno":2078773400,"pcpadd":"Elmwood Primary Care,211 Main St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"ELMWOOD PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 TEN LOTS RD","madd2":"","madd3":"","mcity":"OAKLAND","mstate":"ME","mzip":"04963","pcpfaxno":2078773401,"pcpnpi":1831645563,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6X35Y51NY71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E113511","E113512","R1011","H40013","Z0000","E119","N1830","L600","B351","L97812","D472","D631","G8929","I10","H9313","Z1231","I728","I129","E1122","N179","I70293","N281","L97811","M5450","I890","I080","R609","Z5941","Z87891","R399","M79674","M79675","L97918","L03115","L97919","Z7982","E1129","I82811","E11649","I872","R809","Z7984","E669","E11622","K8020","R932","K760","R92323","E1169","R600","H4311","M9903","M5136","M9904","M5451","L02212"],"date":["2025-11-06","2025-11-06","2024-08-01","2025-11-06","2025-11-06","2023-01-03","2025-08-13","2023-03-23","2025-10-07","2025-07-17","2025-08-13","2025-08-13","2023-01-03","2025-01-23","2023-01-03","2025-08-12","2025-04-22","2025-07-08","2025-10-10","2024-12-23","2025-05-30","2024-11-08","2025-07-24","2024-06-05","2025-06-09","2024-01-29","2025-03-31","2025-11-06","2025-11-06","2023-10-11","2023-12-18","2023-12-18","2025-08-06","2025-01-23","2025-04-22","2025-04-22","2023-10-24","2025-03-31","2025-06-30","2025-03-31","2023-10-24","2023-02-22","2023-02-22","2025-01-20","2024-11-08","2024-11-08","2025-05-05","2025-08-12","2025-02-06","2023-12-20","2022-11-23","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-09-28"],"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":[["","","TRAMADOL HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","INSULIN DEGLUDEC PEN (U-100)","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","LANTUS","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","LEVEMIR","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","BETAMETHASONE VALERATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}