{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ruth J Vanarsdale","gend":1,"currentgend":"","add":"294 PINE TREE ROAD","city":"LITCHFIELD","state":"ME","zip":"04350","dob":"1947-09-09","age":"","mstatus":"","insh":"10000048039","cliId":"","pno":2072684061,"cno":2075578096,"email":"rvnakvak@fairpoint.net","ename":"","eno":"","pphy":"CRAWFORD, KARA M","ppno":2076218800,"pcpadd":"Augusta Family Medicine,15 Enterprise Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"AUGUSTA FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"294 PINE TREE ROAD","madd2":"","madd3":"","mcity":"LITCHFIELD","mstate":"ME","mzip":"04350","pcpfaxno":2076218801,"pcpnpi":1578654505,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3WH8H04FJ62","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M810","R2689","M25562","Z471","Z01810","R9431","Z0100","L570","L821","L814","D3131","M175","X32XXXA","L309","L280","Z1211","M21062","Z96652","D0439","Z1231","D122","Z122","Z4789","D125","Z87891","M1712","M25561","Z0000","Z09","H25812","H40033","H538","H25813","N1831","Z13820","M25461","M25462","L718","L218","D485","M5450","M47816","M4187","M48061","M4316","Z0101","H25811","Z96653","M948X6","G8918","F17210","D649","R232"],"date":["2024-12-11","2024-12-11","2024-05-22","2025-10-09","2023-09-19","2023-09-19","2025-09-02","2025-04-08","2025-04-08","2025-04-08","2025-09-02","2023-10-09","2025-04-08","2025-04-08","2025-04-08","2023-07-31","2024-05-14","2025-10-09","2023-05-16","2024-05-10","2023-07-31","2023-10-30","2023-10-10","2023-07-31","2023-10-30","2023-06-01","2023-06-01","2025-09-24","2024-10-03","2023-12-12","2023-12-11","2023-12-11","2023-12-11","2024-09-25","2023-11-13","2023-12-14","2023-12-14","2023-04-04","2023-04-04","2024-04-08","2025-04-01","2025-04-01","2025-04-01","2025-04-01","2025-04-01","2023-05-18","2023-05-18","2023-10-20","2023-10-20","2023-10-09","2022-10-11","2022-10-05","2022-09-12"],"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":[["","","AMOXICILLIN","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","RALOXIFENE HCL","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}