{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary K Trafton","gend":1,"currentgend":"","add":"192 OHIO HILL RD","city":"FAIRFIELD","state":"ME","zip":"04937","dob":"1957-09-12","age":"","mstatus":"","insh":"10000040021","cliId":"","pno":2073137385,"cno":2073137385,"email":"refused@refused.com","ename":"","eno":"","pphy":"LOPEZ, SHARON E","ppno":"","pcpadd":"Belgrade Regional Health Center,4 Clement Way","pcpcity":"Belgrade","pcpstate":"ME","pcpzip":"04917","pcpcounty":"","pcpid":"","pcpname":"BELGRADE REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"192 OHIO HILL RD","madd2":"","madd3":"","mcity":"FAIRFIELD","mstate":"ME","mzip":"04937","pcpfaxno":"","pcpnpi":1548746316,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9TM6VH3RM57","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","J449","E7800","E8342","Z23","R918","Z79899","K8020","J9811","J189","R7881","C44529","L905","M542","J9601","D492","L720","A419","J441","J9691","J9809","J929","I2510","Z1231","J90","L03313","C4492","Z87891","I10","J869","R590","C44722","F411","G894","L219","L821","C44629","R197","R911","F419","E871","R921","Z86008","J8489","R920","D72828","D75839","D649","Z483","R9389","B953","R0902","I339","Z9981","R791","Z780","I700","J984","Z98890","K838","F17210","Z85828","F17200","Z712"],"date":["2024-09-11","2025-11-03","2023-09-25","2023-09-25","2025-02-24","2025-08-15","2025-05-23","2025-03-21","2025-03-21","2025-06-05","2025-04-22","2023-06-29","2023-06-29","2024-03-07","2025-04-11","2023-01-04","2023-07-13","2025-02-24","2025-03-02","2025-02-24","2025-08-15","2025-08-15","2025-08-15","2023-09-26","2025-02-28","2023-05-19","2023-05-10","2023-05-10","2024-06-10","2025-03-04","2025-08-15","2023-06-29","2024-06-10","2024-06-10","2023-01-04","2023-04-12","2023-06-29","2025-03-24","2025-08-15","2025-09-19","2025-02-22","2023-10-09","2023-06-29","2025-02-25","2023-10-09","2025-02-23","2025-02-23","2025-10-30","2023-05-12","2025-05-12","2025-03-04","2025-02-26","2025-03-03","2025-02-24","2025-02-24","2023-09-26","2025-04-25","2025-08-15","2025-08-15","2025-02-24","2022-08-15","2022-08-15","2022-07-06","2022-07-06"],"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":[["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","DILTIAZEM 24HR ER (XR)","","","Select","Select",""],["","","DILT-XR","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","STIOLTO RESPIMAT","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","UMECLIDINIUM-VILANTEROL","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","KETOCONAZOLE","","","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":""}]}]}