{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cheryl W Smith","gend":1,"currentgend":"","add":"63 GOULDS RIDGE RD","city":"PASSADUMKEAG","state":"ME","zip":"04475","dob":"1951-02-18","age":"","mstatus":"","insh":"10000047666","cliId":"","pno":2077327146,"cno":"","email":"DOBBREEDER@AOL.COM","ename":"","eno":"","pphy":"ADAMS, KATIE M","ppno":2079737979,"pcpadd":"PO BOX 99,","pcpcity":"LINCOLN","pcpstate":"ME","pcpzip":"44570099","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"63 GOULDS RIDGE RD","madd2":"","madd3":"","mcity":"PASSADUMKEAG","mstate":"ME","mzip":"04475","pcpfaxno":2077948476,"pcpnpi":1154764975,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2XQ0WA8PN11","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K219","M5412","M9901","M542","M9907","M9902","E559","Z1231","I10","K5792","H25813","Z860100","C328","Z510","K5730","C320","C329","Z01812","Z77098","N200","K5732","N281","H25811","H25812","H35433","H26493","H43813","I6523","L820","S2232XA","Z87891","M5441","Z0101","H5203","H524","H52223","M85852","M85851","Z0000","J383","R490","M48061","M5116","M4726","M4316","G8929","R221","Z800","N6489","Z122","S299XXA","M50120","M4722","Z5111","K6389","Z452","C323","Z803","R922","I6521","Z9841","H26491","R040"],"date":["2025-07-10","2023-04-04","2023-09-14","2024-11-12","2023-09-14","2023-09-14","2024-06-20","2025-07-14","2025-10-13","2025-03-21","2024-08-26","2024-10-22","2025-11-14","2025-10-01","2024-10-22","2025-11-04","2025-10-07","2025-09-12","2025-09-14","2024-09-06","2024-09-06","2024-09-06","2024-07-30","2024-09-24","2024-07-30","2025-01-20","2025-01-20","2024-10-25","2023-05-24","2023-01-07","2025-09-29","2023-01-09","2024-06-19","2024-06-19","2024-06-19","2024-06-19","2023-05-25","2023-05-25","2025-04-07","2025-07-07","2025-07-07","2022-12-07","2022-12-07","2022-12-07","2022-12-07","2024-10-04","2025-08-14","2025-09-29","2022-12-08","2024-06-13","2023-01-07","2024-10-04","2024-10-04","2025-10-06","2025-03-21","2025-09-12","2025-11-10","2025-09-04","2022-12-08","2024-10-25","2024-09-24","2024-09-13","2022-09-29"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SILVER SULFADIAZINE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","DEXAMETHASONE","","","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":""}]}]}