{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jacqueline D Morrill","gend":1,"currentgend":"","add":"184 STONE HILL RD","city":"LIMERICK","state":"ME","zip":"04048","dob":"1953-04-21","age":"","mstatus":"","insh":"10000059771","cliId":"","pno":2077938464,"cno":"","email":"","ename":"","eno":"","pphy":"GALBRAITH, KATHRYN L","ppno":"","pcpadd":"44 ELM ST,","pcpcity":"LIMERICK","pcpstate":"ME","pcpzip":"40483924","pcpcounty":"","pcpid":"","pcpname":"GALBRAITH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"184 STONE HILL RD","madd2":"","madd3":"","mcity":"LIMERICK","mstate":"ME","mzip":"04048","pcpfaxno":2077939587,"pcpnpi":1740240290,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4WU6CC3XR47","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","R7301","M7071","Z23","M25551","S22080A","S32030A","E539","F0280","I10","F0150","R634","M47816","G3184","E1165","Z0101","H5203","M51360","Z1231","S32030D","M5450","Z0001","S32039A","G301","R413","F02B0","M1611","Z8781","F02A0","H5213","E538","L4050","I6782"],"date":["2024-08-08","2025-08-01","2023-10-26","2025-10-09","2025-04-17","2025-04-17","2025-04-17","2025-06-01","2023-01-05","2025-08-01","2025-08-01","2025-07-28","2025-04-09","2023-08-31","2025-05-19","2025-01-30","2024-01-25","2025-04-09","2025-03-27","2025-04-09","2025-04-09","2023-11-02","2025-04-17","2025-04-24","2025-04-24","2025-04-24","2025-04-17","2025-04-17","2025-01-17","2025-01-30","2023-05-05","2022-06-01","2022-04-23"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","HYDROCORTISONE BUTYRATE","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}