{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan J Staples","gend":1,"currentgend":"","add":"31 OLD COUNTY RD","city":"Brooklin","state":"ME","zip":"04616","dob":"1950-04-06","age":"","mstatus":"","insh":"10000040645","cliId":"","pno":2073594419,"cno":"","email":"oakumbay@gmail.com","ename":"","eno":"","pphy":"JARVIS, BETHANY L","ppno":2073742311,"pcpadd":"PO BOX 587,","pcpcity":"AUGUSTA","pcpstate":"ME","pcpzip":"43320587","pcpcounty":"","pcpid":"","pcpname":"ELLSWORTH FAMILY PLANNING AND PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"31 OLD COUNTY RD","madd2":"","madd3":"","mcity":"Brooklin","mstate":"ME","mzip":"04616","pcpfaxno":2073743984,"pcpnpi":1144262791,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4GK3W42UY16","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","G3184","Z0000","I10","Z114","E538","R42","R4189","I959","Z0100","Z7901","Z79899","R413","Z1159","R399","R944","Z1231","N6322","N6325","N6489","N289","H3561","F32A","H029","L900","H0012","Z0189","R001","R9431","F418","I6782","Z48817","C4492","Z483","C44729","L570","Z888","I480","R259","H539","F419","Z4802","L989"],"date":["2024-09-09","2024-07-03","2025-06-06","2024-12-11","2024-07-01","2025-05-02","2023-10-11","2024-08-10","2023-08-16","2025-04-17","2024-11-14","2023-05-10","2025-09-15","2024-07-02","2024-03-19","2024-09-09","2023-04-17","2025-06-13","2025-06-13","2025-06-13","2023-08-02","2024-03-22","2024-01-25","2024-01-25","2023-01-06","2024-02-02","2025-04-02","2025-09-15","2023-05-11","2024-09-09","2022-09-16","2022-09-15","2022-09-21","2022-09-19","2022-09-07","2022-09-07","2022-09-07","2022-09-07","2022-08-31","2022-08-31","2022-07-01","2022-06-29","2022-06-13"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","HALOBETASOL PROPIONATE","","","Select","Select",""],["","","MECLIZINE HCL","","","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":""}]}]}