{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pamela Page","gend":1,"currentgend":"","add":"56 MARKS LAKE RD","city":"MARSHFIELD","state":"ME","zip":"04654","dob":"1949-09-29","age":"","mstatus":"","insh":"10000054097","cliId":"","pno":2072553523,"cno":"","email":"PPAGE@MYFAIRPOINT.NET","ename":"","eno":"","pphy":"RIOUX, DAVID C","ppno":2072553356,"pcpadd":"11 HOSPITAL DR,","pcpcity":"MACHIAS","pcpstate":"ME","pcpzip":"46543325","pcpcounty":"","pcpid":"","pcpname":"DOWN EAST COMMUNITY HOSPITAL MEDICAL ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"56 MARKS LAKE RD","madd2":"","madd3":"","mcity":"MARSHFIELD","mstate":"ME","mzip":"04654","pcpfaxno":2072550705,"pcpnpi":1316084650,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2Q21EW1EE14","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R102","D3131","H04123","H35373","Z961","I83813","L821","Z0000","J449","R030","G250","R0602","Z1211","R200","M79671","J329","M810","Z0001","B370","Z1231","H43813","D124","D122","S52031D","I83893","S52021D","S52022A","S30861A","S52021A","I2720","J45901","R062","M25551","S62309A","S42409A","E7800","L570","S52091D","N9489","L309","S52592D","H903","Z4789","S52572D","S52692D","Z189","S70261A","I872","R0789","M7989","L281","H00022","Z4689","J45909"],"date":["2024-02-09","2025-11-06","2025-11-06","2024-03-26","2024-03-26","2024-05-23","2023-04-17","2025-04-15","2025-07-23","2023-09-13","2023-09-13","2025-07-23","2025-04-09","2025-08-20","2025-08-20","2025-02-24","2025-04-24","2023-03-13","2024-02-05","2025-03-18","2025-11-06","2025-04-02","2025-04-02","2025-09-05","2024-04-22","2025-09-11","2025-06-13","2023-10-30","2025-06-15","2025-05-12","2025-07-16","2025-07-16","2025-06-26","2025-06-15","2025-06-15","2023-09-13","2023-09-13","2025-09-11","2024-02-16","2024-11-05","2025-09-11","2023-05-24","2025-06-15","2025-08-01","2025-08-01","2024-10-28","2024-11-18","2024-01-29","2025-04-30","2024-05-08","2023-04-17","2023-07-24","2025-07-01","2022-09-12"],"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":[["","","PRIMIDONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AIRSUPRA","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CYCLOSPORINE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","LAGEVRIO (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":""}]}]}