{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bonnie L Luce","gend":1,"currentgend":"","add":"25 WELCH ST","city":"NORRIDGEWOCK","state":"ME","zip":"04957","dob":"1951-02-05","age":"","mstatus":"","insh":"10000044894","cliId":"","pno":2076342223,"cno":"","email":"declined@101824.com","ename":"","eno":"","pphy":"Tomasz, Sarah M","ppno":2076344366,"pcpadd":"RMPC NORRIDGEWOCK HEALTH CENTER,87 MERCER RD","pcpcity":"NORRIDGEWOCK","pcpstate":"ME","pcpzip":"04957","pcpcounty":"","pcpid":"","pcpname":"RMPC NORRIDGEWOCK HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 175","madd2":"","madd3":"","mcity":"NORRIDGEWOCK","mstate":"ME","mzip":"04957","pcpfaxno":2076344375,"pcpnpi":1144678970,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3AM9K26HQ59","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","J208","R6889","I10","H353132","H2513","H903","J40","U071","Z1231","H43813","R059","H527","R7989","R0981","M5450","J189","D72819","R21","Z23","M8580","R918","H3530"],"date":["2025-04-30","2023-09-22","2023-03-21","2025-01-31","2025-06-10","2025-06-10","2024-02-08","2024-12-10","2023-10-24","2022-11-09","2025-06-10","2025-01-06","2025-06-10","2024-04-01","2025-01-16","2024-07-29","2022-10-31","2023-04-07","2022-08-13","2024-09-18","2022-10-03","2022-10-03","2022-10-03"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","FLOVENT HFA","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","QVAR REDIHALER","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","OLOPATADINE HCL","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}