{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alma C Scully","gend":1,"currentgend":"","add":"34 Evergreen Farms Rd","city":"Scarborough","state":"ME","zip":"04074","dob":"1931-04-01","age":"","mstatus":"","insh":"10000053841","cliId":"","pno":7169124514,"cno":"","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"00000","pcpcounty":"","pcpid":"","pcpname":"","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"34 Evergreen Farms Rd","madd2":"","madd3":"","mcity":"Scarborough","mstate":"ME","mzip":"04074","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9V75NE2PD88","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L601","E1159","L851","B351","M79674","M79675","S40019A","M25469","W1839XA","I10","Z950","I5032","R55","R1310","Z45018","Z0000","G309","I69391","F0150","F0280","I4811","M8000XD","C4491","E119","Z794","D508","G308","L84","M79671","M79672","R262","R051","E1122","E039","Z954","R531","M8008XD","M4856XD","R1031","M549","I499","R112","S32030G","M8588","S32030S","S32038D","A000","I480","S32030A","R109","I4891","Z7901","E1165","N1831","I8003","H5789","I080","M8008XG","K5730","N281","Z8673","M4850XA","I2510","R319","S32030D","R238","E1142","E1129","R809"],"date":["2023-04-04","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-08-05","2024-08-05","2024-08-05","2025-04-24","2025-05-29","2025-02-27","2025-03-20","2024-12-04","2024-01-12","2024-01-04","2025-05-06","2024-11-25","2025-05-06","2025-05-06","2023-05-17","2024-02-02","2023-02-09","2023-02-14","2023-02-14","2023-02-14","2024-05-13","2023-06-06","2023-06-06","2023-04-04","2023-06-06","2023-10-09","2023-10-09","2023-10-09","2023-05-17","2025-03-20","2024-02-22","2022-09-25","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2022-10-19","2022-10-19","2023-06-12","2022-10-19","2022-09-27","2025-01-23","2022-09-16","2022-09-16","2022-09-25","2022-09-16","2024-08-29","2024-04-09","2023-06-06","2022-10-04","2023-06-07","2025-03-10","2022-09-15","2022-09-15","2022-09-17","2022-09-23","2025-01-23","2022-09-19","2022-09-16","2024-04-29","2024-01-23","2022-06-16","2022-06-16"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","MORPHINE SULFATE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY READER","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","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":""}]}]}