{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wanda A Ellis","gend":1,"currentgend":"","add":"1260 TREMONT RD","city":"SEAL COVE","state":"ME","zip":"04674","dob":"1953-06-27","age":"","mstatus":"","insh":"10000060849","cliId":"","pno":2072449239,"cno":"","email":"","ename":"","eno":"","pphy":"KANDUTSCH, MARK A","ppno":2072885119,"pcpadd":"10 WAYMAN LN,","pcpcity":"BAR HARBOR","pcpstate":"ME","pcpzip":"46091625","pcpcounty":"","pcpid":"","pcpname":"CADILLAC FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1260 TREMONT RD","madd2":"","madd3":"","mcity":"SEAL COVE","mstate":"ME","mzip":"04674","pcpfaxno":2072888449,"pcpnpi":1194795799,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7U25U77RK79","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M19072","H35373","H2513","H04123","Z885","E785","K2270","M2041","U071","A6920","M79672","M2011","H608X2","H6092","G4733","H6123","H01006","Z0000","R6889","M25511","H2511","H2512","H61892","H35341","R21","G4736","N760","R5383","B029","M25531","M25562","L0390","H43813","L03112","G4700","R0683","R2689","A6923","G4731","M79671","M6281","K22719","K449","Z86010"],"date":["2025-09-10","2023-11-08","2024-09-26","2024-03-07","2023-03-10","2023-09-05","2024-05-30","2025-05-07","2023-12-29","2023-05-14","2024-04-22","2025-05-07","2024-01-12","2022-12-19","2025-09-04","2024-01-12","2025-06-30","2025-07-22","2023-03-21","2022-11-28","2025-01-08","2025-01-29","2022-12-15","2024-03-07","2024-05-15","2025-06-24","2025-08-11","2025-09-04","2023-05-03","2024-03-11","2024-11-07","2023-04-17","2023-11-08","2023-04-10","2025-09-04","2025-09-04","2024-10-08","2024-07-01","2023-09-11","2022-09-01","2022-08-10","2022-08-31","2022-08-31","2022-08-31"],"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":[["","","ONDANSETRON HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ACETIC ACID","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","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":""}]}]}