{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rhaedella E Farrin","gend":1,"currentgend":"","add":"21 KINGS PARK WAY","city":"MOUNT DESERT","state":"ME","zip":"04660","dob":"1951-09-28","age":"","mstatus":"","insh":"10000050430","cliId":"","pno":2072889097,"cno":2077712004,"email":"declined@080522.com","ename":"","eno":"","pphy":"HANSON, CASEY S","ppno":2076675899,"pcpadd":"PO BOX 8,","pcpcity":"BAR HARBOR","pcpstate":"ME","pcpzip":"46090008","pcpcounty":"","pcpid":"","pcpname":"TRENTON HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"21 KINGS PARK WAY","madd2":"","madd3":"","mcity":"MOUNT DESERT","mstate":"ME","mzip":"04660","pcpfaxno":2078015123,"pcpnpi":1164536397,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1C83GF8TP78","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","K567","I499","F325","Z0100","D3131","I10","M170","E039","H532","M1712","Z1231","M1711","M25562","F5105","S2231XA","S299XXA","R1031","L0201","R053","J0110","M7918","R1013","H35363","R6889","R519","L03019","M25561"],"date":["2025-04-25","2022-12-27","2024-02-23","2024-02-28","2024-10-24","2023-07-24","2024-11-06","2024-04-08","2024-02-28","2024-02-23","2023-01-24","2024-11-07","2024-04-08","2024-04-08","2025-03-03","2024-04-12","2024-04-12","2024-04-13","2024-10-04","2023-05-16","2024-02-23","2025-06-24","2022-12-27","2024-10-24","2022-08-22","2022-08-25","2022-06-10","2022-02-15"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","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":""}]}]}