{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dawn M Walston","gend":1,"currentgend":"","add":"171 COURT ST","city":"Machias","state":"ME","zip":"04654","dob":"1948-04-18","age":"","mstatus":"","insh":"10000042437","cliId":"","pno":2072558417,"cno":"","email":"dawn.walston@yahoo.com","ename":"","eno":"","pphy":"RIOUX, DAVID C","ppno":2072553356,"pcpadd":"11 HOSPITAL DR,","pcpcity":"MACHIAS","pcpstate":"ME","pcpzip":"46543325","pcpcounty":"","pcpid":"","pcpname":"DOWN EAST COMMUNITY HOSPITAL MEDICAL ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"171 COURT ST","madd2":"","madd3":"","mcity":"Machias","mstate":"ME","mzip":"04654","pcpfaxno":2072550705,"pcpnpi":1316084650,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2MH0HE3YC26","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25512","S83203D","J40","S83209A","M1990","R197","I10","E119","I129","H9201","E1122","L0390","M23241","E11621","L97519","M79661","N6019","Z0000","E785","N1832","R928","N6489","M7121","Z01812","M2041","M25561","M19012","L570","S83249A","S83289A","S838X9A","Z1231","L97509","M898X7","L84","L603","Z1211","K635","Z09","Z23","N1831","M7630","E1165"],"date":["2023-09-13","2025-08-06","2025-09-02","2025-07-08","2025-06-11","2025-08-19","2025-07-29","2025-07-29","2025-06-03","2025-07-08","2023-08-30","2024-01-23","2025-04-28","2024-09-24","2024-09-24","2025-07-08","2024-07-31","2024-11-25","2023-08-30","2025-02-26","2023-05-25","2023-05-25","2025-02-12","2025-04-05","2024-11-13","2024-12-18","2023-08-31","2024-11-20","2025-02-25","2025-05-13","2025-02-12","2025-08-15","2024-08-27","2024-04-08","2024-04-08","2024-03-04","2025-08-29","2025-08-29","2025-08-15","2022-10-11","2022-10-11","2022-10-11","2022-09-16"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","VANCOMYCIN HCL","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FLUARIX TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","KERENDIA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","DAPAGLIFLOZIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ABRYSVO","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}