{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Betty M Breton","gend":1,"currentgend":"","add":"7 DAVIS RD","city":"DURHAM","state":"ME","zip":"04222","dob":"1941-11-17","age":"","mstatus":"","insh":"10000044256","cliId":"","pno":2073532590,"cno":"","email":"declined@06082021.com","ename":"","eno":"","pphy":"SALKO, DAVID L","ppno":2077986200,"pcpadd":"4 HORTON PL,STE. 101","pcpcity":"TOPSHAM","pcpstate":"ME","pcpzip":"40861747","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 DAVIS RD","madd2":"","madd3":"","mcity":"DURHAM","mstate":"ME","mzip":"04222","pcpfaxno":2077986290,"pcpnpi":1659338879,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2J57RJ7KF20","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":["R0789","C719","Z7901","J690","Z950","J189","G9389","H2512","R269","R569","H18513","H18233","I4819","Z09","I4891","N390","R4182","Z1211","Z043","I110","I509","I10","H35371","R410","J811","J181","J929","Z0101","H524","H52223","H5201","Z961","T450X5A","R531","H52221","H5203","R079","I4720","K635","R399","R6889","R300","T17300A","R002","E785","R930","R1110","G939","Z0000","M5030","R001","Z885","J9601","Z87440","C711","C712","I361","I77810","I517","I495","E871","J984","J9809","R0602","I4821","J209","Z780","M8580","Z86010","K5730","Z1231"],"date":["2025-08-25","2023-12-10","2025-10-07","2024-05-16","2025-10-08","2025-10-08","2025-05-02","2025-09-23","2024-05-24","2025-03-11","2025-09-23","2022-11-30","2025-09-18","2025-10-21","2025-05-29","2025-09-30","2025-10-04","2023-01-03","2024-05-21","2025-05-20","2025-10-07","2025-10-21","2022-11-30","2025-10-04","2025-10-07","2025-10-07","2025-10-07","2025-09-23","2025-09-23","2025-09-23","2025-09-23","2025-09-23","2025-10-04","2025-06-19","2024-09-03","2024-09-03","2025-08-25","2024-03-06","2023-01-03","2025-09-10","2023-08-31","2025-09-09","2024-05-20","2024-03-04","2024-06-24","2023-03-27","2025-06-19","2025-05-02","2024-08-14","2023-06-15","2025-10-08","2024-01-27","2025-10-08","2025-09-30","2023-12-10","2023-12-10","2025-05-21","2024-03-19","2025-05-21","2024-03-25","2024-05-31","2025-06-19","2024-05-17","2025-08-30","2025-09-18","2025-01-01","2024-08-14","2024-08-14","2023-01-03","2023-01-03","2022-09-09"],"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":[["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","OXCARBAZEPINE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","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":[]}},{"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":""}]}]}