{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Frances Miliano","gend":1,"currentgend":"","add":"103 PARK ST","city":"FARMINGDALE","state":"ME","zip":"04344","dob":"1951-08-17","age":"","mstatus":"","insh":"10000049491","cliId":"","pno":2074417900,"cno":"","email":"fcm103@roadrunner.com","ename":"","eno":"","pphy":"STRICKLAND, DONALD J","ppno":2076238434,"pcpadd":"\tKennebec Internal Medicine,9 Glenridge Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"KENNEBEC INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"103 PARK ST","madd2":"","madd3":"","mcity":"FARMINGDALE","mstate":"ME","mzip":"04344","pcpfaxno":2076214370,"pcpnpi":1861431819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3GM0Y58UX46","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M2042","M79675","M7541","R6889","I10","Z4789","C44722","M170","D2372","L089","M7918","C44519","L84","M79672","Z1211","Z1212","Z1231","Z0100","H40013","Z23","M25561","M25562","L700","Z0000","M1712","M25511","M7732","S39012A","X58XXXA","Z5333","Z01419","Z124","Z1239","S93119A","M8588","M85851","M85852","Z780","E785","M174","C44612","C44622","M7742","Z09","R0789","D485","E039","R079","J929","R5383","Z79899","Z13820","R252","M8589","R21","N1831","L821","D225","L570","C44729","I1310","X32XXXA","I129","L820","L298","H10211","N1830","D649","M898X9","R809","L989","J189","S299XXA","R0600","U071","G609","G629","M1990","M1711","Z853"],"date":["2023-12-11","2023-10-31","2025-11-06","2023-12-23","2025-10-28","2024-02-07","2025-06-12","2025-08-26","2024-02-27","2024-02-27","2025-06-10","2025-01-15","2023-02-23","2023-12-11","2025-09-09","2025-09-09","2025-01-14","2025-04-15","2025-04-15","2025-09-30","2024-10-01","2024-10-01","2025-03-10","2025-08-26","2023-08-23","2025-04-16","2023-12-11","2025-01-18","2025-01-18","2023-10-31","2023-12-14","2023-12-14","2023-12-14","2023-12-06","2025-10-24","2025-10-24","2025-10-24","2025-10-24","2025-08-26","2023-01-31","2024-02-27","2024-02-27","2025-04-24","2023-12-06","2023-08-18","2025-04-03","2025-08-26","2023-08-18","2023-08-18","2024-11-21","2024-10-01","2025-10-24","2025-06-10","2023-10-23","2024-11-21","2025-08-26","2024-02-14","2024-02-14","2024-12-03","2024-02-27","2025-02-12","2024-12-03","2025-02-05","2024-02-14","2024-02-14","2025-09-25","2025-02-12","2023-02-16","2023-02-16","2025-02-12","2024-02-12","2022-11-12","2022-11-12","2022-11-12","2022-10-04","2022-08-30","2022-08-29","2022-08-29","2022-08-30","2022-08-24"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","AMMONIUM LACTATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}