{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carol E Wallace","gend":1,"currentgend":"","add":"478 GARLAND RD","city":"DEXTER","state":"ME","zip":"04930","dob":"1950-06-03","age":"","mstatus":"","insh":"10000041688","cliId":"","pno":2079243459,"cno":"","email":"wallace4261@gmail.com","ename":"","eno":"","pphy":"MACDONALD, MICHAEL C","ppno":2073736848,"pcpadd":"22 STATION AVE,SUITE 101","pcpcity":"BRUNSWICK","pcpstate":"ME","pcpzip":"40112092","pcpcounty":"","pcpid":"","pcpname":"SEBASTICOOK FAMILY DOCTORS","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"478 GARLAND RD","madd2":"","madd3":"","mcity":"DEXTER","mstate":"ME","mzip":"04930","pcpfaxno":2073736849,"pcpnpi":1235220740,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4TM1XJ8XT12","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40003","H40013","R300","E039","S32030A","Z1211","D225","L814","L821","L400","S3992XA","S32038D","S52571A","R002","N6459","R92322","R079","R051","R0602","R1110","Z0000","Z13820","Z1231","S52591A","I38","R5383","I10","E785","R739","W19XXXA","S52591D","Y999","M810","R0789","Q676","M5136","M47816","W109XXA","Y9301","F411","S52501A","L570","L448","L298","R208","L538","I4891","W108XXA","B372","M8588","Z0101","H43813","Z961","D485","L650","H40011","H40012","S52571D","S60911A","F514","K219"],"date":["2025-04-28","2025-04-28","2023-08-25","2023-06-28","2024-08-06","2025-05-21","2024-10-30","2024-10-30","2024-10-30","2024-10-30","2024-06-02","2024-06-03","2024-06-03","2023-06-28","2024-06-24","2024-06-24","2024-02-28","2023-10-13","2023-10-13","2023-10-13","2025-05-07","2025-05-07","2025-07-15","2024-06-07","2024-03-22","2024-03-05","2024-02-14","2024-02-14","2024-02-14","2024-08-06","2024-06-07","2024-06-07","2025-07-15","2024-02-14","2023-10-13","2024-08-06","2024-08-06","2024-06-03","2024-06-03","2025-10-29","2024-06-28","2025-11-07","2023-10-18","2023-10-18","2023-10-18","2023-10-18","2023-05-17","2024-06-28","2025-06-16","2023-02-08","2023-10-04","2024-04-22","2023-10-04","2025-11-07","2024-03-12","2024-04-22","2024-04-22","2024-06-28","2024-06-02","2025-09-29","2022-11-07"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","PRAZOSIN HCL","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","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":""}]}]}