{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janelle M Gath","gend":1,"currentgend":"","add":"26 MARIE ST","city":"WINSLOW","state":"ME","zip":"04901","dob":"1953-07-04","age":"","mstatus":"","insh":"10000062195","cliId":"","pno":2076166015,"cno":"","email":"janellegath@gmail.com","ename":"","eno":"","pphy":"ELLIS, DANIELLE","ppno":2078731181,"pcpadd":"Waterville Family Practice,31 Front St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"WATERVILLE FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"26 MARIE ST","madd2":"","madd3":"","mcity":"WINSLOW","mstate":"ME","mzip":"04901","pcpfaxno":2078731186,"pcpnpi":1295046597,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9H10W31RG05","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5189","M75102","E785","M62838","M12812","M25812","M66812","M797","Z0101","Z4789","M25511","M9900","M9901","M9902","Z1211","R6889","R531","M75121","M19011","M25512","M546","M19012","M5450","M542","M9908","M9903","M21612","R4189","J0190","Z98890","M12811","K5730","Z1231","Z1283","D229","L821","R238","G8929","M75101","M810","D225","L570","M8589","Z0000","Z139","Z1389","Z1331","M9905","M9904","M9907","M75122","S46812A","M25412","H9190","Z23","Z7689","D224","L814"],"date":["2023-11-15","2023-03-30","2025-03-20","2024-04-15","2024-07-19","2023-03-30","2023-03-30","2025-10-07","2025-03-12","2023-05-09","2023-07-20","2024-04-15","2024-04-15","2024-03-04","2025-03-20","2023-12-13","2023-08-30","2023-01-17","2024-07-19","2023-03-13","2024-04-15","2024-07-19","2024-04-15","2024-04-15","2024-03-04","2024-04-15","2024-12-19","2024-03-13","2023-10-30","2023-08-30","2024-07-19","2025-03-20","2025-04-01","2024-11-14","2024-11-14","2024-11-14","2024-11-14","2024-01-08","2023-03-20","2024-11-12","2023-11-09","2023-11-09","2023-12-14","2024-11-20","2024-11-20","2024-11-20","2024-11-20","2024-04-15","2023-09-25","2023-09-25","2023-02-04","2023-02-04","2023-02-04","2022-11-15","2022-11-15","2022-10-19","2022-10-04","2022-10-04"],"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":[["","","SHINGRIX","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}