{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marlene A Dwelley","gend":1,"currentgend":"","add":"60 MOUNTAIN VIEW DR","city":"Baileyville","state":"ME","zip":"04694","dob":"1952-01-15","age":"","mstatus":"","insh":"10000051481","cliId":"","pno":2074276139,"cno":"","email":"marlenenjem@yahoo.com","ename":"","eno":"","pphy":"MUNRO, SHANNON C","ppno":2074548233,"pcpadd":"CCH Internal Medicine,37 Palmer St Ste 2","pcpcity":"Calais","pcpstate":"ME","pcpzip":"04619","pcpcounty":"","pcpid":"","pcpname":"CCH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"60 MOUNTAIN VIEW DR","madd2":"","madd3":"","mcity":"Baileyville","mstate":"ME","mzip":"04694","pcpfaxno":"","pcpnpi":1295828499,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3NQ0N16VR24","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M0579","M05741","M0589","I10","R29898","M810","R269","Z79899","R739","E785","H3550","H2513","M05742","M2550","M8580","E8342","M069","R011","I3481","R5383","Z79631","Z471","Z111","R531","Z96641","M79642","M79641","F32A"],"date":["2025-09-23","2025-06-11","2025-05-21","2023-01-30","2025-03-06","2024-12-02","2025-07-28","2025-05-23","2025-04-14","2025-04-14","2024-11-19","2024-11-19","2024-06-03","2025-03-19","2024-11-18","2023-08-22","2025-07-22","2024-12-03","2024-12-03","2025-04-14","2024-02-01","2025-04-21","2025-05-23","2025-04-14","2022-09-29","2022-08-30","2022-08-29","2022-07-26"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","RENFLEXIS","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","LEFLUNOMIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ENBREL SURECLICK","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","SODIUM CHLORIDE","","","Select","Select",""],["","","INFLECTRA","","","Select","Select",""],["","","DIPHENHYDRAMINE HCL","","","Select","Select",""],["","","INFLIXIMAB","","","Select","Select",""],["","","AVSOLA","","","Select","Select",""],["","","RASUVO","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ENBREL","","","Select","Select",""],["","","REMICADE","","","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":{"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":[]}},{"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":""}]}]}