{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ruth A Baker","gend":1,"currentgend":"","add":"161 HIGH ST","city":"Bath","state":"ME","zip":"04530","dob":"1953-08-03","age":"","mstatus":"","insh":"10000061811","cliId":"","pno":2078370274,"cno":"","email":"ottoone1@comcast.net","ename":"","eno":"","pphy":"PANOZZO, SHASHI T","ppno":2078469013,"pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"161 HIGH ST","madd2":"","madd3":"","mcity":"Bath","mstate":"ME","mzip":"04530","pcpfaxno":2075238586,"pcpnpi":1255301701,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5PR9HW5KW38","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K435","K5730","L989","Z1211","K5792","K635","K648","Z433","Z0001","K612","E785","I10","G8918","M7989","J9811","I2510","K7689","R911","Z98890","M179","A000","H903","M1711","M1990","M47816","Z0000","L570","D225","L821","L578","J849","R509","R109","N289","K769","R932","Z48815","Z933","K649","Z23","M8580","R6889","K5720","R229","J040","H1132","L659","M5489","L259","Z1231","D122","Z860101","Z139","Z01818","F17200","Z0101","H52223","H524","H5201","H2513","R1084","K5732","I7090","N83202","N83292","D259","R9389","M8589","Z780","R609","M549","R319","Z13220","R5381","M7910","R935","H9202","H6982","M9903","S39012A","M9904","M5431","M9906","M9902","M9901"],"date":["2023-01-17","2025-04-18","2025-10-17","2025-04-18","2023-01-17","2025-04-18","2025-04-18","2023-01-17","2025-10-06","2022-11-28","2023-01-17","2023-01-17","2023-01-17","2024-11-07","2022-11-30","2022-11-30","2022-11-30","2022-11-30","2023-02-16","2024-05-31","2022-12-04","2024-09-05","2024-08-31","2024-08-31","2024-08-31","2025-09-26","2025-04-07","2025-04-07","2025-04-07","2025-04-07","2022-11-28","2022-11-28","2023-01-10","2023-01-10","2023-01-10","2023-01-10","2023-01-03","2023-01-12","2023-01-12","2024-10-02","2025-09-26","2023-03-23","2022-11-25","2024-11-07","2025-03-22","2023-03-17","2023-03-10","2023-06-02","2025-05-05","2025-05-20","2025-04-18","2025-04-18","2025-04-18","2022-11-17","2022-11-25","2022-11-08","2022-11-08","2022-11-08","2022-11-08","2022-11-08","2022-10-21","2022-10-21","2022-10-21","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-08-12","2022-08-12","2022-07-14","2022-07-14","2022-06-23","2022-06-22","2022-06-03","2022-06-03","2022-06-03","2022-04-04","2022-04-04","2021-12-06","2021-11-15","2021-12-06","2021-11-15","2021-12-06","2021-12-06","2021-12-06"],"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":[["","","DIAZEPAM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","NEOMYCIN SULFATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","PNEUMOVAX 23","","","Select","Select",""],["","","GABAPENTIN","","","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":""}]}]}