{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan J Merrill","gend":1,"currentgend":"","add":"476 MOSES CHAPMAN RD","city":"PORTER","state":"ME","zip":"04068","dob":"1960-02-16","age":"","mstatus":"","insh":"10000047875","cliId":"","pno":2076259313,"cno":"","email":"opt-out@optout.com","ename":"","eno":"","pphy":"LETELLIER, TERESA","ppno":2072831441,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 238","madd2":"","madd3":"","mcity":"PARSONSFIELD","mstate":"ME","mzip":"04047","pcpfaxno":2075231136,"pcpnpi":1629431622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8G88EG3WP67","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":["J0110","J441","C4331","Z428","Z85820","B070","R918","J90","R509","R748","L02411","Z6820","F17210","J40","Z1231","Z8673","Z13228","I10","C44301","L089","H00025","D492","C439","G9389","J449","F418","H00014"],"date":["2024-01-05","2024-01-05","2025-11-13","2025-10-15","2025-10-15","2024-04-23","2023-07-23","2023-07-23","2023-07-23","2023-07-23","2024-05-02","2024-05-02","2025-10-08","2024-01-22","2025-06-20","2025-06-16","2025-06-16","2023-04-06","2025-10-02","2024-09-01","2023-10-25","2025-09-02","2025-11-07","2025-11-07","2025-10-08","2025-10-08","2023-12-20"],"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":[["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","LIDOCAINE-PRILOCAINE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}