{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ruth A Reynolds","gend":1,"currentgend":"","add":"40 MERRILL RD APT 2","city":"Lewiston","state":"ME","zip":"04240","dob":"1949-01-31","age":"","mstatus":"","insh":"10000042395","cliId":"","pno":2073190062,"cno":"","email":"RUTHABR@ROADRUNNER.COM","ename":"","eno":"","pphy":"LATKOVICH, KATARINA Z","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400 CENTRAL MAINE INTERNAL MEDICINE","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"40 MERRILL RD APT 2","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":2077955727,"pcpnpi":1902878499,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1DX4UJ5UF81","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R2689","H903","H6122","J329","R109","I10","R42","E6601","M6281","U071","Z87891","Z1152","R1012","N281","Z9049","K760","K5730","Z1231","R195","G4733","R002","Z98890","M47816","R0602","R059","Z90710","R1084","Z780","R011","I700","R0689","R000","M5136","M549","R739","Z0000","R55","M5126","M5127","M47817","H16223","M810","I350","D72829","I951","R066","J45909","K5900","E66813","S0990XA","K3189","H6190","M79605","E7800","R6889","I739","I83812","H9191","M79662","R0600","H2513","I8392","I872"],"date":["2025-03-05","2023-03-01","2023-03-01","2023-03-01","2023-08-09","2025-09-18","2025-01-03","2024-10-07","2025-02-12","2023-10-29","2023-10-29","2023-10-29","2023-12-19","2022-12-22","2023-08-09","2023-08-09","2023-08-09","2025-04-02","2023-12-27","2025-09-08","2024-01-01","2023-05-02","2023-05-02","2023-10-29","2023-10-29","2023-08-09","2023-06-29","2025-04-14","2024-12-27","2023-06-15","2023-10-29","2023-10-29","2023-04-26","2023-04-25","2024-03-21","2023-04-25","2024-12-30","2023-04-26","2023-04-26","2023-04-26","2025-03-27","2025-04-14","2025-03-04","2024-12-25","2024-12-30","2023-01-12","2023-05-15","2023-05-15","2025-09-25","2024-12-25","2023-02-01","2022-10-13","2022-10-13","2022-10-13","2022-08-19","2022-04-21","2022-04-21","2022-03-24","2022-03-01","2021-10-22","2022-02-02","2022-02-16","2022-02-16"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","BYDUREON BCISE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE QUAD 2023-2024","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","GABAPENTIN","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}