{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia C Vachio","gend":1,"currentgend":"","add":"12 MERGANSER ST","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1942-04-23","age":"","mstatus":"","insh":"10000061404","cliId":"","pno":2078879328,"cno":8604806226,"email":"vachio@ATT.net","ename":"","eno":"","pphy":"HA NGOC, TIN","ppno":2078392559,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 MERGANSER ST","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":2078287850,"pcpnpi":1073877791,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2J13F87TW17","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N3281","R269","H6123","N3941","R152","E785","I10","N952","F0154","K591","R5383","R29898","K529","E860","R1031","Z23","F0150","G3109","F0280","R1013","Z87891","E7800","R159","K5730","G44229","M069","N281","K449","R1110","Z0101","Z98890","R6889","Z462","R351","R300","K5900","I6782","M8580","G319","G9389","R531","N390","R3915","R2689","K52831","H5211","R197","R4189","R296","M7910","R3121","R5381","R6883","R519","L821"],"date":["2025-09-16","2024-08-28","2023-06-14","2025-09-16","2023-05-25","2025-03-27","2025-10-27","2023-09-28","2025-10-06","2024-08-01","2024-08-01","2025-10-21","2024-08-01","2024-08-01","2024-08-01","2025-09-26","2025-10-06","2024-05-29","2024-05-29","2023-05-27","2025-03-27","2024-05-09","2023-05-25","2023-05-27","2024-06-21","2024-06-21","2024-08-01","2024-08-01","2024-08-01","2025-04-22","2023-06-06","2023-04-12","2023-05-25","2024-05-07","2024-05-14","2025-03-27","2024-03-13","2025-09-11","2025-10-18","2025-10-18","2025-10-18","2024-05-14","2025-08-25","2024-03-13","2023-06-29","2025-04-22","2025-10-27","2025-10-27","2025-10-27","2022-11-24","2022-10-26","2022-11-24","2022-11-24","2022-11-24","2022-08-26"],"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":[["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TROSPIUM CHLORIDE","","","Select","Select",""],["","","MYRBETRIQ","","","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":""}]}]}