{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dana L Trafton","gend":1,"currentgend":"","add":"157 NORTH ST","city":"Calais","state":"ME","zip":"04619","dob":"1950-01-06","age":"","mstatus":"","insh":"10000038445","cliId":"","pno":2074547081,"cno":"","email":"","ename":"","eno":"","pphy":"INCANNELLA, ELIZABETH M","ppno":2074548195,"pcpadd":"CCH Family Medicine,37 Palmer St Ste 3","pcpcity":"Calais","pcpstate":"ME","pcpzip":"04619","pcpcounty":"","pcpid":"","pcpname":"CCH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"157 NORTH ST","madd2":"","madd3":"","mcity":"Calais","mstate":"ME","mzip":"04619","pcpfaxno":2074543840,"pcpnpi":1275145393,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2CD1F06DH37","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H26493","Z1211","M8589","D225","L814","L821","Z08","H2511","L570","R809","Z0001","Z85820","L820","R208","L538","F419","H40013","I10","H26492","H2512","E119","I788","Z1231","B079","H26491","N390","Z0000","Z780","D485","H524","L853","R6889","D1801","L400","H2513"],"date":["2024-01-23","2025-01-27","2023-01-20","2025-08-25","2025-08-25","2025-08-25","2022-11-09","2022-11-14","2025-08-25","2023-09-19","2022-11-18","2025-08-25","2025-08-25","2025-08-25","2025-08-25","2025-03-18","2025-06-09","2023-08-16","2024-02-12","2022-10-31","2022-10-11","2024-06-19","2025-03-10","2025-02-24","2024-02-15","2024-07-26","2024-09-13","2023-01-20","2025-02-24","2024-03-12","2025-02-24","2022-12-21","2023-06-07","2023-06-07","2022-08-31"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","COMBIGAN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}