{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carol L Nelson","gend":1,"currentgend":"","add":"285 MAIN RD","city":"EDDINGTON","state":"ME","zip":"04428","dob":"1950-03-08","age":"","mstatus":"","insh":"10000049461","cliId":"","pno":2077356741,"cno":"","email":"declined@05152023.com","ename":"","eno":"","pphy":"Langley, Amy A","ppno":"","pcpadd":"PO BOX 1599,","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"BREWER MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"285 MAIN RD","madd2":"","madd3":"","mcity":"EDDINGTON","mstate":"ME","mzip":"04428","pcpfaxno":2079470435,"pcpnpi":1083906622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6NG1TU8CV29","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J449","R109","K219","R0902","Z87891","Z122","Z98891","E8342","E8340","R112","H353211","R7303","R0602","I493","E119","E559","E785","H353222","H43813","G4733","J9611","R918","I491","M8589","Z1231","H353221","H26493","R5383","Z23","K2970","K449","K319","K222","H3530","R1310","I2720","H43811","K5730","N281","K429","M25561","M1711"],"date":["2025-06-17","2024-02-09","2024-04-09","2024-04-09","2025-05-23","2024-06-03","2023-05-31","2024-08-16","2024-08-16","2023-10-16","2025-04-21","2023-09-26","2024-08-14","2024-08-30","2025-01-08","2024-08-16","2023-09-26","2025-01-22","2024-08-28","2025-06-17","2023-06-28","2023-06-28","2024-08-30","2024-09-13","2024-09-13","2023-10-13","2023-10-13","2022-10-06","2025-01-08","2023-10-16","2023-10-16","2023-10-16","2024-07-09","2023-04-04","2024-07-09","2024-11-14","2025-01-22","2024-02-01","2024-02-01","2024-02-01","2022-07-08","2022-07-08"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","SPIRIVA HANDIHALER","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","SYMBICORT","","","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":{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}