{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sheila A Hanscom","gend":1,"currentgend":"","add":"282 FROST ST","city":"LINCOLN","state":"ME","zip":"04457","dob":"1948-09-16","age":"","mstatus":"","insh":"10000043882","cliId":"","pno":2077942282,"cno":"","email":"declined@080125.com","ename":"","eno":"","pphy":"ALESSI, CARL F","ppno":2077943296,"pcpadd":"Penobscot Valley Hospital,7 Transalpine Rd","pcpcity":"Belfast","pcpstate":"ME","pcpzip":"04915","pcpcounty":"","pcpid":"","pcpname":"PENOBSCOT VALLEY PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"282 FROST ST","madd2":"","madd3":"","mcity":"LINCOLN","mstate":"ME","mzip":"04457","pcpfaxno":2077948072,"pcpnpi":1144214271,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5A07TX7KY50","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":["M25531","E785","F322","I130","N1832","M533","M5450","E119","S6291XA","I10","S63501A","S52572D","S52572A","R8290","Z09","Z96653","T63481A","E1140","M2042","M2041","N1830","Z01818","Z0101","H524","Z961","S61412A","Z1231","I129","R1031","H26492","M19031","B351","M810","J209","M720","M65322","H26491","H43813","E1122","Z23","Z0000","Z1211","Z780","K6289","M1811","S61452A","M25532","S52532A","E782","M654"],"date":["2024-01-11","2024-08-02","2024-08-02","2023-10-20","2023-11-03","2024-10-10","2024-10-10","2025-08-06","2025-06-25","2024-08-02","2024-02-01","2025-09-24","2025-06-27","2025-08-08","2025-09-10","2023-09-28","2025-05-27","2024-12-19","2024-12-19","2024-12-19","2023-10-18","2025-08-20","2024-01-29","2024-01-29","2024-01-29","2023-11-06","2025-02-25","2023-02-28","2023-02-28","2025-05-13","2024-01-11","2025-09-23","2025-09-22","2024-07-01","2025-09-24","2025-09-24","2025-04-24","2025-04-24","2023-02-16","2025-08-08","2025-08-08","2025-09-10","2025-09-22","2025-09-10","2024-01-03","2023-10-26","2025-06-27","2025-06-25","2025-11-06","2022-09-06"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","IBANDRONATE SODIUM","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}