{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia A Wallack","gend":1,"currentgend":"","add":"88 CEDAR LN","city":"OGUNQUIT","state":"ME","zip":"03907","dob":"1944-03-11","age":"","mstatus":"","insh":"10000062212","cliId":"","pno":2076462950,"cno":6034983345,"email":"Declined@01122023.com","ename":"","eno":"","pphy":"ADAMS, TODD","ppno":2076468386,"pcpadd":"York Hospital Internal Medicine of York,277 Post Rd","pcpcity":"Moody","pcpstate":"ME","pcpzip":"04054","pcpcounty":"","pcpid":"","pcpname":"WEBHANNET INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"P.O. BOX 578","madd2":"","madd3":"","mcity":"Moody","mstate":"ME","mzip":"04054","pcpfaxno":2076412855,"pcpnpi":1427165778,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9X91CA4QU13","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H2512","R4181","I69354","R040","E042","H16223","S0592XA","M19011","M19012","Z1231","R0902","I10","S0003XA","S40912A","W19XXXA","R2689","F4323","F5101","M720","R296","R52","M79602","Z743","M1990","H2511","R627","S40011A","S40012A","S0990XA","F419","R891","R0602","Z1211","Z043","I639","F329","G4700","E785","R531","D649","Z800","T783XXA","R220","S51012A","J9811","I517","G608","B351","S0083XA","M542","H25813","K219","J181","L89312","D225","L814","L821","Z08","D485","J9691","Z0101","H524","M79672","H04123","H18599","H01139","Z23","E559","M7501","J189","R600","R635","Z0000","M25512","M25511","R42","M6281","R1312","J984","I160","Z8673","L89892","R7301","G603","S0512XA","L570","L820","R208","L538","D2371","J069","N6321"],"date":["2023-12-18","2025-07-18","2025-08-22","2023-03-09","2023-03-09","2024-12-02","2024-12-02","2025-03-13","2025-03-13","2024-02-28","2025-10-13","2025-08-24","2025-07-05","2025-03-13","2025-07-05","2023-03-01","2025-07-25","2025-09-26","2023-09-27","2025-08-24","2025-08-24","2025-08-24","2025-08-24","2025-08-24","2023-12-18","2025-08-28","2025-03-13","2025-03-13","2024-07-31","2025-08-08","2025-05-02","2025-05-02","2023-05-24","2024-04-30","2025-10-02","2025-08-08","2025-08-08","2025-09-24","2025-08-24","2025-10-08","2023-05-24","2025-07-05","2025-07-05","2023-06-02","2025-10-28","2025-10-28","2025-05-21","2023-01-30","2024-07-31","2024-07-31","2023-04-11","2024-02-05","2025-10-13","2025-07-03","2023-11-20","2023-11-20","2023-11-20","2023-11-20","2023-11-20","2025-10-04","2023-01-10","2023-01-10","2025-08-15","2023-08-09","2023-08-09","2023-11-20","2025-10-29","2025-09-26","2023-03-24","2025-10-13","2025-10-13","2025-10-13","2024-09-13","2025-08-24","2025-08-24","2025-05-02","2025-08-22","2025-08-22","2025-10-05","2025-04-29","2025-03-24","2025-06-03","2024-09-10","2022-10-31","2022-11-18","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-07-28","2022-07-26"],"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":[["","","TOLTERODINE TARTRATE ER","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PRAZOSIN HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}