{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Grace E Walton","gend":1,"currentgend":"","add":"303 PINKHAM RD","city":"Pittston","state":"ME","zip":"04345","dob":"1952-09-28","age":"","mstatus":"","insh":"10000055716","cliId":"","pno":2076897691,"cno":2076897691,"email":"gwalton4321@gmail.com","ename":"","eno":"","pphy":"TRELEASE BELL, AMY L","ppno":2076261561,"pcpadd":"15 E CHESTNUT ST,","pcpcity":"AUGUSTA","pcpstate":"ME","pcpzip":"43305736","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICINE INSTITUTE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"303 PINKHAM RD","madd2":"","madd3":"","mcity":"Pittston","mstate":"ME","mzip":"04345","pcpfaxno":2076261849,"pcpnpi":1801994561,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6GP3VU5VW77","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S72092A","E7800","G20A1","S6991XD","S52501D","Z0001","S72002D","Z4789","Z578","Z634","R2689","I2510","K219","Z1231","G20C","S72002A","Z471","M25552","Z87891","I6523","I10","E782","S52501A","Z96642","R0602","K2950","R1013","R140","X58XXXD","G20","Z79899","J449","J8410","M85851","M85852","Z780","M7062","Z7951","Z8616","R399","T1490XA","K5900","G988","Z9049","Z743","Z0100","Z853","Z0000","I340","I509","I700","J45991","M9903","M9904","M9905","S335XXA","Z4889","M62838","M25551","G20A2","S52571A","K638219","J45909","Z579","M25512","S72052A","K2090","M9906","Z87440","Z8711","M79652","M79602","R6889","S52591D","S63501A","Z13820","R4189","E785","R269","Z713","U099","M6281"],"date":["2024-10-22","2025-01-31","2025-10-06","2024-04-22","2023-11-20","2025-09-29","2025-04-10","2024-11-05","2024-11-05","2025-07-30","2023-08-14","2025-08-13","2024-10-20","2025-02-03","2025-08-27","2024-12-16","2025-03-20","2025-06-26","2025-07-30","2025-08-13","2025-08-13","2025-08-13","2023-05-15","2025-06-13","2023-11-30","2024-03-01","2024-03-01","2025-05-05","2023-11-20","2023-09-18","2025-06-03","2023-04-06","2023-04-06","2025-11-10","2025-11-10","2025-11-10","2025-08-11","2024-03-06","2023-12-08","2025-09-22","2024-10-19","2024-03-28","2023-12-08","2024-02-06","2024-10-19","2023-10-30","2022-12-22","2023-10-30","2023-03-07","2023-03-07","2023-03-07","2024-09-11","2024-12-17","2024-12-17","2025-06-13","2023-08-31","2025-01-10","2025-06-13","2025-06-13","2025-02-05","2023-04-25","2024-05-09","2025-07-30","2025-07-30","2024-08-29","2024-10-21","2024-03-01","2024-12-17","2024-02-06","2024-02-06","2025-09-04","2024-08-29","2023-01-28","2023-05-15","2023-04-22","2025-11-10","2022-11-17","2022-11-07","2022-09-14","2022-09-14","2022-09-14","2022-08-10"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA ER","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","COLESEVELAM HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","BACLOFEN","","","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":""}]}]}