{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan E Lowe","gend":1,"currentgend":"","add":"2 BAYVIEW TERRACE","city":"PORTLAND","state":"ME","zip":"04103","dob":"1951-07-07","age":"","mstatus":"","insh":"10000048718","cliId":"","pno":2077721415,"cno":"","email":"declined@12142024.com","ename":"","eno":"","pphy":"KIM, REGINA Y","ppno":2075351340,"pcpadd":"MERCY WEST FALMOUTH PRIMARY CARE,75 GRAY RD","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"04105","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2 BAYVIEW TERRACE","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2075351358,"pcpnpi":1104906155,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8FP8A60RK30","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C180","M4312","M47812","M542","R519","Z1211","Z85038","K5730","K648","F411","G8929","M9901","M9902","M546","M25572","K5720","F17290","L600","B351","K5792","R0602","D649","Z0000","K769","M47816","G4700","F419","M5450","I351","K5750","M549","F4323","I10","E785","R9431","R4182","M25552","M160","F339","Z13220","Z1231","D229","R6889","D0461","J209","U099","R062","R5383","F17200","F4321","Z87891","Z79899","L989","L821","I781","L814","K5900","Z853","D239","C189","M5136","K5732","Z0001","Z08","K635","F17210","Z7982","C50919","H2513","D3101","H5202","Z1371","E7800","C188","C50911","C50912","Z170","Z483","S52571D","Z4789"],"date":["2024-08-30","2024-08-02","2024-08-02","2025-03-05","2024-08-02","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-08-05","2025-10-09","2025-03-05","2025-03-05","2025-03-05","2024-05-22","2024-08-09","2024-08-09","2023-08-15","2023-08-15","2024-06-10","2024-06-10","2024-06-21","2025-08-11","2024-06-07","2025-11-13","2025-04-14","2025-04-14","2025-04-21","2024-05-23","2024-08-30","2025-09-10","2025-04-01","2025-07-29","2024-05-23","2024-05-23","2024-08-30","2025-03-17","2025-03-17","2024-06-21","2024-06-21","2025-10-08","2025-09-18","2023-01-17","2025-09-11","2023-05-06","2023-05-06","2023-05-06","2023-05-06","2024-03-27","2025-07-18","2025-03-13","2025-03-13","2025-09-11","2023-03-27","2023-03-27","2023-03-27","2024-05-07","2024-05-04","2025-09-11","2025-09-11","2024-08-02","2024-05-04","2024-07-31","2025-10-08","2024-07-24","2023-06-21","2025-06-17","2022-12-06","2024-11-15","2024-11-15","2024-11-15","2024-11-19","2023-07-03","2024-11-19","2024-11-19","2024-11-19","2023-08-28","2024-09-16","2022-08-16","2022-08-16"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","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":""}]}]}