{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janice C May","gend":1,"currentgend":"","add":"143 NORRIDGEWOCK AVE","city":"SKOWHEGAN","state":"ME","zip":"04976","dob":"1952-12-17","age":"","mstatus":"","insh":"10000057660","cliId":"","pno":2073996773,"cno":2073996434,"email":"janassmay@icloud.com","ename":"","eno":"","pphy":"ISRAEL, JACLYN","ppno":2076344366,"pcpadd":"87 MERCER RD,","pcpcity":"NORRIDGEWOCK","pcpstate":"ME","pcpzip":"49573168","pcpcounty":"","pcpid":"","pcpname":"RMPC NORRIDGEWOCK HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"143 NORRIDGEWOCK AVE","madd2":"","madd3":"","mcity":"SKOWHEGAN","mstate":"ME","mzip":"04976","pcpfaxno":2076344375,"pcpnpi":1154904712,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3DN9U45RP49","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01818","I10","Z471","M25551","M67853","R030","I8393","Z96641","Z0000","Z1231","M1611","Z1283","Z299","M160","M869","M25519","R748","B009","Z0101","L820","R21","S6991XD","M65851","E785","N898","M1651","R600","G8929","N952","R7982","Z87891","M00851","S025XXA","M2170","K219","L821","L851","C44519","M79641","N1831","Z09","L578","M79651","H04123","D235","D2371","Z01419","M5136","M86151","R609","M25451","M5127","M5126","M47817","M47816","Z4889"],"date":["2024-10-11","2023-12-08","2025-11-03","2024-05-17","2024-10-23","2023-06-19","2024-09-26","2025-11-03","2025-09-05","2024-07-30","2024-10-26","2024-01-29","2024-04-01","2024-02-23","2024-02-13","2023-01-11","2023-10-26","2024-04-26","2025-02-03","2024-01-29","2024-03-06","2025-09-19","2024-10-23","2024-10-23","2023-07-11","2024-10-23","2024-01-22","2024-03-08","2025-03-24","2024-02-23","2024-02-23","2024-06-07","2023-07-03","2024-10-23","2024-10-23","2025-04-01","2022-12-19","2023-01-19","2025-05-02","2025-01-17","2024-04-29","2022-12-19","2024-04-24","2023-02-27","2022-12-19","2022-12-19","2022-09-20","2022-08-08","2022-07-05","2022-07-05","2022-07-05","2022-07-05","2022-07-05","2022-07-05","2022-07-05","2022-06-23"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","LOTEPREDNOL ETABONATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","VANCOMYCIN HCL","","","Select","Select",""],["","","DIFICID","","","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":""}]}]}