{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rebecca Hotelling","gend":1,"currentgend":"","add":"3 FOGGS POINT ROAD","city":"FREEPORT","state":"ME","zip":"04032","dob":"1941-03-31","age":"","mstatus":"","insh":"10000045320","cliId":"","pno":2078653292,"cno":"","email":"declined@09232022.com","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":2077745816,"pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 FOGGS POINT ROAD","madd2":"","madd3":"","mcity":"FREEPORT","mstate":"ME","mzip":"04032","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2HP7V20UK57","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K529","M1711","Z1231","M25512","M25511","M25561","H401231","Z98890","L270","B351","L565","Z0000","H401232","Z96651","Z471","L858","G603","M79671","M79672","M23306","M2391","D704","L219","L578","Z85828","R197","Q845","L853","M79674","M79675","E7800","G8918","R112","H6123","R55","A084","Z0001","R262","H409","R42","H903","R5383","R21","M1712","M25462","M25562","M25461","H527","S80861A","K52832","Q828","H8111","G8929","H8112","R053","R0982","Z87891","H8113","D492","M2040","L820","L570","L718","M170","K52839","Z461","Z7189","Z803","Z800","M23331","K4090","R4182","Z23","H04123","R110","R1013","R1031","L728","L03115","K439","K5900","H401230","L821","L308","L249"],"date":["2025-01-17","2025-01-21","2024-09-24","2025-10-24","2025-10-24","2025-01-14","2024-09-19","2025-01-21","2023-06-26","2025-09-25","2025-05-01","2024-05-09","2025-10-28","2025-04-22","2025-01-25","2025-09-25","2025-09-25","2025-09-25","2025-09-25","2024-05-28","2024-05-28","2024-06-20","2025-05-01","2025-05-01","2025-05-01","2024-10-14","2023-08-22","2023-08-22","2023-04-13","2023-04-13","2024-05-02","2025-01-21","2025-01-21","2024-10-10","2024-04-15","2024-09-30","2023-02-13","2023-05-23","2023-02-13","2023-02-13","2023-02-20","2024-10-04","2023-06-05","2025-08-01","2025-08-01","2025-10-27","2024-03-05","2025-10-28","2023-06-26","2025-01-17","2024-02-29","2023-02-14","2025-10-27","2023-03-01","2024-04-12","2024-04-12","2024-04-12","2023-02-16","2024-02-29","2023-04-13","2023-03-03","2023-03-03","2023-03-03","2024-03-27","2025-05-21","2024-08-20","2023-08-15","2023-08-15","2023-08-15","2024-02-10","2022-11-02","2022-11-02","2022-11-17","2022-11-01","2022-10-04","2022-10-04","2022-09-21","2022-08-25","2022-06-11","2022-04-28","2022-04-28","2021-10-19","2022-01-24","2022-01-24","2022-02-18"],"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":[["","","LATANOPROST","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BUDESONIDE DR","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","BUDESONIDE ER","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":""}]}]}