{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth H Harmon","gend":1,"currentgend":"","add":"46 INTREPID ST","city":"Brunswick","state":"ME","zip":"04011","dob":"1946-06-15","age":"","mstatus":"","insh":"10000051362","cliId":"","pno":2078448805,"cno":"","email":"BETHHARMON2@GMAIL.COM","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":2077745816,"pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2072333881,"add2":"","add3":"","madd1":"46 INTREPID ST","madd2":"","madd3":"","mcity":"Brunswick","mstate":"ME","mzip":"04011","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4K37NF5RW49","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5416","M5450","I2510","G8918","M1711","E039","K219","M25561","M25661","R262","R600","Z23","M9905","M5459","M9903","R229","T50Z95D","Z0001","Z471","K625","K5730","Z1231","M4316","M47816","G5601","Z96651","M5136","H43813","Z01818","M654","M1812","G5603","M51360","E785","E669","M79602","J209","I700","M8580","G8929","Z8616","G3184","M25461","Z0101","H40013","K635","M25551","I214","M4726","M48061","G5602","K644","R202","M65332","M65342","M8588","J189","M6530","T881XXD","S83271A","M7121","M2241","Z6832","D751","M23341","M5417","M222X1","M25562","K047","K029","Z96652","M47896","M7062","M479","M7061","Z96659","C44319","M6281","C44310"],"date":["2023-05-09","2025-06-09","2024-11-15","2024-06-17","2024-06-17","2025-06-17","2024-06-17","2024-08-15","2024-08-15","2024-08-15","2024-08-15","2024-12-11","2024-06-07","2024-06-07","2024-06-07","2022-12-12","2022-12-12","2024-12-11","2024-08-14","2024-04-11","2024-02-08","2025-01-22","2025-04-08","2025-02-10","2025-06-17","2024-07-01","2023-02-03","2023-12-08","2024-05-24","2025-03-28","2025-05-09","2025-05-09","2024-12-11","2025-06-17","2025-06-17","2024-05-23","2025-02-11","2023-11-07","2024-12-11","2023-06-13","2023-06-13","2024-05-09","2024-07-01","2025-07-22","2025-07-22","2024-02-08","2023-07-05","2023-02-02","2023-03-17","2023-03-17","2025-07-25","2024-04-11","2025-01-28","2025-01-28","2025-01-28","2023-01-27","2025-02-18","2023-11-07","2022-11-02","2022-10-26","2022-10-26","2022-10-26","2022-11-02","2022-11-02","2022-10-26","2022-08-31","2022-06-16","2022-06-06","2022-05-19","2022-05-19","2022-05-09","2022-05-05","2022-05-05","2022-04-19","2022-04-19","2022-03-17","2021-10-13","2021-10-25","2021-11-17"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}