{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Myrtle R Mckenney","gend":1,"currentgend":"","add":"185 W OLD MAIN RD","city":"WEST ENFIELD","state":"ME","zip":"04493","dob":"1949-11-05","age":"","mstatus":"","insh":"10000038099","cliId":"","pno":2077323790,"cno":"","email":"trouble5204493@yahoo.com","ename":"","eno":"","pphy":"ALESSI, CARL F","ppno":2077943296,"pcpadd":"Penobscot Valley Hospital,7 Transalpine Rd","pcpcity":"Belfast","pcpstate":"ME","pcpzip":"04915","pcpcounty":"","pcpid":"","pcpname":"PENOBSCOT VALLEY PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"185 W OLD MAIN RD","madd2":"","madd3":"","mcity":"WEST ENFIELD","mstate":"ME","mzip":"04493","pcpfaxno":2077948072,"pcpnpi":1144214271,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8XV0WP2CH01","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","M7061","M1612","N952","Z23","E785","Z1231","Z0100","H524","H52223","Z471","Z96641","Z1212","Z1211","M25551","E6601","Z6841","Z96643","Z8679","H43813","Z01818","R6889","R600","R5383","M1611","E669","F419","E7800","F418","Z20822","M25559","E782"],"date":["2025-10-03","2024-12-01","2023-08-25","2025-03-24","2024-11-04","2025-09-09","2025-03-21","2025-10-08","2024-05-20","2024-05-20","2024-10-11","2024-10-11","2023-11-07","2023-11-07","2024-10-11","2023-08-25","2023-08-25","2023-09-08","2024-04-22","2025-10-08","2023-08-09","2022-10-07","2022-09-14","2022-09-14","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-09","2022-06-24","2022-06-24"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PREGABALIN","","","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":""}]}]}