{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan J Franklin","gend":1,"currentgend":"","add":"176 ATLANTIC AVE","city":"WELLS","state":"ME","zip":"04090","dob":"1947-05-19","age":"","mstatus":"","insh":"10000053246","cliId":"","pno":2076463269,"cno":"","email":"mefpsp@yahoo.com","ename":"","eno":"","pphy":"TREMBLAY, CHRISTINE","ppno":2076460676,"pcpadd":"WELLS FAMILY PRACTICE,59 MILE RD","pcpcity":"WELLS","pcpstate":"ME","pcpzip":"04090","pcpcounty":"","pcpid":"","pcpname":"WELLS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"176 ATLANTIC AVE","madd2":"","madd3":"","mcity":"WELLS","mstate":"ME","mzip":"04090","pcpfaxno":"","pcpnpi":1457434573,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1PQ9TF2RC32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E113211","E113292","Z794","Z7984","H25811","H25812","H25813","E133293","D511","Z1231","E1065","E119","M654","I10","E8342","E782","M25532","I4710","R32","Z961","D649","R011","D500","E785","I471","G4733","R350","J45909","E781","H6122","H9193","N390","I350","I088","I5030","M1812","I083","M542","M47812","M4802","H903","E669","I080","M159","I872","E1136","F32A","M79604","I739","H2512","H2511","R059","J4520","I352","H25819","Z0000","F329","R0609"],"date":["2024-05-31","2024-05-31","2024-05-31","2024-05-31","2023-11-08","2023-11-15","2023-09-11","2024-03-12","2025-08-06","2024-09-30","2025-09-08","2025-07-24","2025-04-25","2025-07-23","2024-10-16","2024-10-16","2025-01-17","2025-07-16","2025-01-17","2024-03-12","2024-02-05","2023-06-19","2025-03-25","2025-02-28","2023-08-18","2023-08-18","2023-04-17","2023-02-08","2025-07-23","2022-10-26","2022-10-26","2023-05-12","2025-07-09","2025-07-09","2025-07-09","2025-03-28","2023-10-26","2025-08-26","2025-08-26","2025-08-26","2025-06-12","2025-07-23","2024-07-01","2024-03-13","2024-07-30","2023-11-15","2023-11-15","2024-07-30","2024-07-30","2023-11-15","2023-11-08","2024-12-05","2023-11-21","2023-11-17","2023-03-24","2023-04-05","2022-09-20","2022-08-23"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","FIASP FLEXTOUCH","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","INSULIN DEGLUDEC PEN (U-200)","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","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":{"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":""}]}]}