{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary J Knight","gend":1,"currentgend":"","add":"25 COUNTRY CLUB RD","city":"South Portland","state":"ME","zip":"04106","dob":"1942-02-13","age":"","mstatus":"","insh":"10000044742","cliId":"","pno":2076538962,"cno":"","email":"declined@081822.com","ename":"","eno":"","pphy":"AIKEN, DOUGLAS","ppno":2078469013,"pcpadd":"Intermed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"110 WATSON RD","madd2":"","madd3":"","mcity":"Poland","mstate":"ME","mzip":"04274","pcpfaxno":2078741483,"pcpnpi":1093774119,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8MF9M73VG40","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R2681","M25562","I151","R531","N390","J189","G9341","Z66","J9601","F02A11","M6281","R269","Z9181","M79605","S299XXA","J90","R188","S300XXA","F0390","I2699","N1831","Z7901","R4189","I129","N184","M25569","S0990XA","R9089","M21061","M25561","M533","M47816","R4182","Z743","R0602","R1311","Z87891","M5136","I10","N2581","Q613","S3993XA","R42","I480","W010XXA","Y92129","F32A","Z86711","M5450","W19XXXA","N200","K5730","N281","R2689","F02B0","J9690","J9811","R918","R0902","M79606","Z7409","S199XXA","R296","K1329","S8992XA","G319","R55","R1011","E785","G3184","M1712","R262","J948","R102","F03B11","J181","K5792","M1711","F331","G894","I2693","N3000","R5383","R404","K5753","R41841","M549","K5780","Z136","I2510","Z23","L821","R079","Z1231","L989","M79673","F329","E7800","E559","E213","E042","R630","E8352","R413","D631","F4323","Z0101","Z961","H26491","R300","Z0000","N179","R197","N189","F320","E860","I130","F411"],"date":["2025-03-17","2024-01-10","2024-01-10","2025-03-17","2025-03-17","2024-07-22","2024-06-30","2024-06-30","2024-07-22","2023-03-22","2024-05-07","2023-03-24","2023-03-24","2023-03-24","2025-05-13","2024-06-26","2024-06-24","2024-04-16","2025-03-26","2024-09-11","2024-11-07","2025-05-13","2024-07-12","2024-05-07","2023-05-11","2023-12-20","2025-05-13","2023-11-20","2024-09-23","2024-01-10","2024-03-23","2024-03-23","2025-05-14","2025-05-13","2024-06-28","2024-01-02","2025-02-16","2024-04-01","2025-03-26","2023-05-11","2023-05-11","2024-03-15","2025-03-26","2025-03-26","2023-11-21","2023-11-21","2023-04-25","2025-05-13","2024-03-22","2025-05-13","2025-02-16","2025-02-16","2025-02-16","2024-09-20","2024-09-20","2024-06-25","2024-06-25","2024-06-24","2024-07-02","2022-12-15","2022-12-16","2025-05-13","2025-02-03","2024-09-11","2022-12-16","2022-12-16","2025-02-16","2024-06-26","2024-02-28","2024-02-28","2022-12-16","2023-10-17","2024-06-25","2024-03-15","2022-12-19","2024-07-13","2025-02-04","2023-10-21","2022-12-28","2022-12-28","2024-06-28","2025-02-19","2025-02-19","2025-02-19","2025-02-05","2025-02-05","2025-02-04","2025-02-04","2024-06-25","2022-11-04","2022-10-03","2022-10-03","2022-10-03","2022-10-12","2022-08-08","2022-08-08","2022-06-08","2022-06-08","2022-06-01","2022-05-17","2022-05-17","2022-05-02","2022-05-02","2022-04-05","2022-03-24","2022-01-18","2021-11-29","2021-11-29","2021-11-29","2021-12-20","2021-12-27","2022-01-27","2022-01-21","2022-01-27","2022-01-27","2022-01-18","2022-01-18","2022-01-18"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","MORPHINE SULFATE","","","Select","Select",""],["","","LORAZEPAM INTENSOL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","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":""}]}]}