{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Georgina Moore","gend":1,"currentgend":"","add":"79 DICKEY MOORE RD","city":"MEDWAY","state":"ME","zip":"04460","dob":"1953-05-28","age":"","mstatus":"","insh":"10000061129","cliId":"","pno":2077466033,"cno":"","email":"gmoore2218@yahoo.com","ename":"","eno":"","pphy":"PERFECT, JODIE","ppno":2077946700,"pcpadd":"175 W BROADWAY,PO BOX 99","pcpcity":"LINCOLN","pcpstate":"ME","pcpzip":"44574000","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"79 DICKEY MOORE RD","madd2":"","madd3":"","mcity":"MEDWAY","mstate":"ME","mzip":"04460","pcpfaxno":2077946777,"pcpnpi":1417399205,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7UV5YM4CQ57","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B351","S91104A","L03031","L97529","L89899","M868X7","L03115","X58XXXA","M25569","I10","R6889","Z1231","M5451","M25561","L03032","M86172","Z0100","Y9301","Y92832","M1711","M79675","E785","E039","E8342","M1A9XX0","G629","Z13220","M546","M869","S99922A","L03116","S93124A","M7989","M19071","T148XXA","Z0000","Z89421","R059","R0982"],"date":["2025-01-24","2023-03-24","2024-04-30","2023-03-31","2024-03-27","2023-03-24","2023-03-24","2023-03-24","2023-09-21","2025-04-30","2023-02-21","2024-12-23","2025-03-11","2023-10-11","2025-09-19","2023-03-24","2025-06-20","2023-03-21","2023-03-21","2024-01-29","2024-11-20","2025-04-30","2025-04-30","2025-04-30","2025-04-30","2024-04-26","2024-04-26","2025-04-08","2024-05-17","2024-05-29","2024-04-30","2023-03-21","2023-03-22","2023-03-21","2024-06-14","2024-04-26","2023-03-24","2022-08-17","2022-08-17"],"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":[["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","CHOLESTYRAMINE","","","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":""}]}]}