{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth S Snow","gend":1,"currentgend":"","add":"792 SOUTHERN BAY RD","city":"PENOBSCOT","state":"ME","zip":"04476","dob":"1952-05-04","age":"","mstatus":"","insh":"10000055285","cliId":"","pno":2073268256,"cno":"","email":"declined@05122020.com","ename":"","eno":"","pphy":"Lesko, Lisa A","ppno":2073742311,"pcpadd":"BLUE HILL FAMILY MEDICINE,57 WATER ST","pcpcity":"BLUE HILL","pcpstate":"ME","pcpzip":"04614","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BLUE HILL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"792 SOUTHERN BAY RD","madd2":"","madd3":"","mcity":"PENOBSCOT","mstate":"ME","mzip":"04476","pcpfaxno":2073742618,"pcpnpi":1720022866,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2RE3EC2NH70","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R1013","C569","N816","N952","S30861","Z9289","G8918","E669","E785","Z8041","S30860A","S70362A","E668","I10","R110","Z0000","R197","H524","H35413","Z0100","Z48815","L03113","M25531","E7800","Z1231","Z1272","K8050","K589","Z8543","Z9049","N200","K8020","K5730","K8010","R1084","E278","Z881","Z885","Z882","M25512","M6281","S46001A","M7910","W57XXXA","S30861A","Z23","B3732"],"date":["2023-08-16","2024-10-28","2024-10-28","2024-10-28","2022-10-19","2024-10-28","2023-09-12","2024-05-08","2024-12-16","2022-10-19","2022-10-19","2023-10-07","2024-01-03","2025-03-26","2023-10-26","2022-11-09","2024-08-15","2024-06-04","2024-06-04","2024-06-04","2023-11-14","2023-07-24","2023-07-23","2024-12-18","2024-12-23","2024-10-28","2023-08-18","2023-08-18","2023-08-18","2023-12-06","2023-08-16","2023-08-16","2023-08-16","2023-08-30","2023-08-16","2023-08-16","2023-08-30","2023-08-30","2023-08-30","2024-10-14","2024-10-14","2024-10-14","2023-12-13","2023-10-07","2022-10-18","2024-10-08","2024-10-28"],"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":[["","","SYNTHROID","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","EZALLOR SPRINKLE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","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":""}]}]}