{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane K Naliboff","gend":1,"currentgend":"","add":"88 HILL TOP RD","city":"Chesterville","state":"ME","zip":"04938","dob":"1951-08-23","age":"","mstatus":"","insh":"10000058883","cliId":"","pno":2072932062,"cno":"","email":"jknaliboff@gmail.com","ename":"","eno":"","pphy":"MADDEN, AMY K","ppno":2076261561,"pcpadd":"PO BOX 274,","pcpcity":"BELGRADE","pcpstate":"ME","pcpzip":"04917","pcpcounty":"","pcpid":"","pcpname":"BELGRADE REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 119","madd2":"","madd3":"","mcity":"Mount Vernon","mstate":"ME","mzip":"04352","pcpfaxno":2074953353,"pcpnpi":1508975152,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6WT5E44HC54","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D509","M2550","E785","Z1231","R9389","N3289","M85852","L820","D225","D2261","Z79890","N950","N840","Z0000","R682","M19072","M79675","Z0101","L821","D229","L810","Z808","M21272","N959","R509","S1096XA","M1812","M79642","M79645","M25532","M25632","M25642","Z23","R208","M65332","I10"],"date":["2025-03-25","2025-03-25","2025-03-25","2025-09-22","2023-05-02","2023-03-21","2025-04-09","2023-04-24","2023-04-24","2023-04-24","2023-05-02","2023-08-17","2023-08-17","2025-03-25","2023-12-12","2024-08-28","2024-08-28","2024-11-12","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2024-09-11","2025-04-09","2024-10-28","2024-10-28","2022-11-15","2022-10-31","2022-11-15","2022-10-31","2022-11-15","2022-11-15","2022-09-23","2022-09-06","2022-08-29","2022-08-29"],"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":[["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","COMBIPATCH","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ESTRADIOL (ONCE WEEKLY)","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL ER","","","Select","Select",""],["","","MENOSTAR","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","OXYCODONE HCL","","","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":""}]}]}