{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Judith A Robbins","gend":1,"currentgend":"","add":"16 OAK RIDGE RD","city":"MOUNT DESERT","state":"ME","zip":"04660","dob":"1952-02-09","age":"","mstatus":"","insh":"10000054265","cliId":"","pno":2074605258,"cno":"","email":"JudyMDI873@gmail.com","ename":"","eno":"","pphy":"HANKE, TANYA","ppno":2072445630,"pcpadd":"10 WAYMAN LN,","pcpcity":"BAR HARBOR","pcpstate":"ME","pcpzip":"46091625","pcpcounty":"","pcpid":"","pcpname":"MDI COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 873","madd2":"","madd3":"","mcity":"MOUNT DESERT","mstate":"ME","mzip":"04660","pcpfaxno":"","pcpnpi":1760644082,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9P44F36DG90","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1611","H33312","H35373","H35033","M9903","S335XXD","H43813","H33313","H34823","M9904","M9906","M62838","M1612","M5136","Z5189","S99921A","M5431","Z471","Z96641","R6889","I10","Z0000","H401131","H43393","H2589","R058","F419","R4182","H33311","H35031","H34821","Z01810","H35371","H25813","J189","R918","R0600","R079","H40013","Z1231","H40053","D649","E2839","M25571","M21751","S76092A","X58XXXA","R32","H538"],"date":["2024-11-04","2024-08-13","2025-03-17","2025-05-27","2025-09-02","2025-09-02","2023-02-15","2025-03-17","2025-03-17","2024-07-09","2024-07-09","2024-07-09","2024-05-17","2024-05-17","2024-07-15","2022-10-03","2024-05-17","2025-02-04","2024-11-20","2023-09-12","2024-11-04","2025-07-21","2025-05-27","2025-05-27","2024-10-23","2025-08-29","2024-11-04","2024-11-04","2023-10-11","2023-10-11","2023-10-11","2024-10-24","2023-10-11","2025-05-27","2025-08-30","2025-08-30","2025-09-05","2025-09-05","2023-09-28","2023-10-13","2023-09-28","2025-09-05","2023-12-06","2025-06-24","2024-11-04","2024-11-04","2024-11-04","2022-09-01","2022-08-12"],"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":[["","","AZITHROMYCIN","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","NP THYROID","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ATOVAQUONE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","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":""}]}]}