{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Judith M Weston","gend":1,"currentgend":"","add":"17 HAWTHORN DRIVE","city":"NORWAY","state":"ME","zip":"04268","dob":"1947-05-03","age":"","mstatus":"","insh":"10000041873","cliId":"","pno":2074201544,"cno":"","email":"","ename":"","eno":"","pphy":"CAMPBELL, CORINNA M","ppno":2074008600,"pcpadd":"St Marys Regional Medical Center Pb,791 Turner St","pcpcity":"Auburn","pcpstate":"ME","pcpzip":"04210","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"17 HAWTHORN DRIVE","madd2":"","madd3":"","mcity":"NORWAY","mstate":"ME","mzip":"04268","pcpfaxno":2077836660,"pcpnpi":1043720667,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2E84CD8CP88","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","R091","R2240","S99822A","R2689","J988","G629","H26491","R2241","M79651","R269","K769","G5601","L570","Z9049","Z800","J45909","E785","F32A","M47812","M4802","M549","K449","M438X4","D1809","M47816","M5126","M51369","M5450","G5603","M542","Z0001","Z0101","M19042","M19041","R059","L299","R0781","R079","C44311","Z79899","S99922A","N390","K8020","R7989","R0789","H35033","M79602","E039","D485","L218","L821","L738","R6889"],"date":["2024-01-22","2023-10-05","2025-08-25","2024-05-29","2024-06-13","2024-02-25","2025-03-27","2025-08-15","2025-08-27","2025-08-27","2025-05-06","2025-08-04","2025-10-07","2025-02-26","2025-04-07","2025-04-07","2025-10-07","2025-10-07","2025-10-07","2025-02-24","2025-02-24","2025-02-24","2025-02-05","2025-02-05","2025-02-05","2025-02-24","2025-02-05","2025-02-05","2025-02-05","2025-07-09","2025-06-09","2025-04-14","2025-07-30","2025-07-09","2025-07-09","2023-10-05","2023-10-05","2023-10-05","2023-09-05","2024-04-09","2024-06-05","2024-05-29","2023-11-08","2023-09-05","2023-09-05","2023-09-05","2023-02-21","2023-09-05","2023-09-05","2023-11-28","2023-11-28","2023-11-28","2023-11-28","2022-08-23"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":""}]}]}