{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carolyn P Smith","gend":1,"currentgend":"","add":"20 MAIN ST","city":"PHILLIPS","state":"ME","zip":"04966","dob":"1939-01-10","age":"","mstatus":"","insh":"10000059188","cliId":"","pno":2073580506,"cno":"","email":"colors@symdak.com","ename":"","eno":"","pphy":"DELUCA, THOMAS J","ppno":2073647831,"pcpadd":"431 FRANKLIN ST,","pcpcity":"RUMFORD","pcpstate":"ME","pcpzip":"42762100","pcpcounty":"","pcpid":"","pcpname":"ELSEMORE DIXFIELD FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2076392373,"add2":"","add3":"","madd1":"20 MAIN ST","madd2":"","madd3":"","mcity":"PHILLIPS","mstate":"ME","mzip":"04966","pcpfaxno":2073699467,"pcpnpi":1154326387,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6HE1YD0TT26","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42","Z7901","Z5181","I4891","S81812A","Z0000","I4820","M2041","R6889","I5032","I509","N1830","S42202A","M25552","N184","I517","R918","J40","J9811","M1612","H903","I071","R0600","N289","I493","R9431","I4811","H43813","H3530","Z961","H5053","N189","G4733","Z0101","H01009","S81819A","E6601","Z6841","E7800","R7301","Z1231","Z79899","R0683","Z471","Z96653","S42202D","S42212A","S42212D"],"date":["2024-08-25","2025-11-04","2025-11-04","2025-11-04","2024-09-27","2025-08-01","2025-10-27","2022-12-06","2022-12-30","2025-01-24","2024-03-24","2024-09-12","2023-02-08","2023-06-13","2024-08-29","2023-09-01","2023-09-01","2023-09-01","2023-09-01","2023-06-13","2023-06-28","2023-07-05","2024-08-25","2023-09-22","2024-08-25","2024-08-25","2023-04-05","2024-10-07","2024-10-07","2024-10-07","2024-10-07","2023-04-27","2024-11-06","2024-02-07","2024-02-07","2024-10-03","2023-05-16","2023-05-16","2023-05-16","2025-09-18","2024-05-13","2024-06-11","2024-10-30","2022-10-26","2022-10-26","2022-10-19","2022-08-09","2022-09-07"],"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":[["","","DILT-XR","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","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":[]}},{"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":""}]}]}