{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jayne R Wixon","gend":1,"currentgend":"","add":"113 PATTEN POND RD","city":"SURRY","state":"ME","zip":"04684","dob":"1952-12-13","age":"","mstatus":"","insh":"10000059451","cliId":"","pno":2074608792,"cno":"","email":"","ename":"","eno":"","pphy":"JARVIS, BETHANY L","ppno":2073742311,"pcpadd":"PO BOX 587,","pcpcity":"AUGUSTA","pcpstate":"ME","pcpzip":"43320587","pcpcounty":"","pcpid":"","pcpname":"ELLSWORTH FAMILY PLANNING AND PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"758 BAYSIDE RD","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2073743984,"pcpnpi":1144262791,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3CA3KU9NH15","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M85852","Z1231","T192XXA","H2512","C8510","E039","H2511","G4733","R918","K449","R222","H40013","Z961","H43393","C8519","H02403","H02831","H02834","D479","R7303","C8330","Z0000","Z7189","M8580","H18832","Z01812","Z23","F4322","E663","Z8572","N760","M8589","J069","H1033","F17210","K259","K319","K219","B070","Z510","C8840","N858","N898","E785","C8512","Z13220","H2513","R5383","H527","R1900","R895","R739"],"date":["2024-11-27","2024-11-27","2025-01-23","2022-11-21","2025-08-01","2025-04-30","2023-01-09","2024-06-07","2024-10-14","2024-09-11","2024-10-29","2025-05-27","2025-05-27","2025-05-27","2025-04-08","2023-05-31","2023-07-21","2023-08-18","2024-10-14","2025-04-30","2024-11-12","2024-10-21","2024-10-21","2025-01-30","2023-05-18","2022-12-02","2023-01-11","2023-05-19","2025-08-01","2024-12-12","2024-12-20","2022-10-05","2023-11-22","2023-11-22","2025-01-30","2024-12-12","2024-12-12","2025-08-01","2023-05-19","2025-04-02","2025-03-12","2024-12-04","2024-12-04","2025-08-01","2024-11-04","2023-05-19","2022-11-08","2024-10-29","2023-02-09","2024-12-20","2024-12-20","2022-07-29"],"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":[["","","TOBRADEX","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}