{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sarah K Pratt","gend":1,"currentgend":"","add":"56 PRICE ST","city":"CALAIS","state":"ME","zip":"04619","dob":"1968-09-28","age":"","mstatus":"","insh":"10000062280","cliId":"","pno":2074540302,"cno":"","email":"","ename":"","eno":"","pphy":"INCANNELLA, ELIZABETH M","ppno":2074548195,"pcpadd":"CCH Family Medicine,37 Palmer St Ste 3","pcpcity":"Calais","pcpstate":"ME","pcpzip":"04619","pcpcounty":"","pcpid":"","pcpname":"CCH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"56 PRICE ST","madd2":"","madd3":"","mcity":"CALAIS","mstate":"ME","mzip":"04619","pcpfaxno":2074543840,"pcpnpi":1275145393,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8TT0W19GH09","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F4312","F606","F411","F331","M722","F410","M25562","E6601","N390","M797","F4000","R519","Z1231","M7062","F4310","N3000","Z882","M79671","M25552","M955","R000","R7303","M62830","U071","R5383","Z79899","F419","R635","R5382","M2170","R102","K7689","K5900","R109","K2900","F4001","N8110","F329","N814","F341"],"date":["2025-08-19","2024-02-21","2025-08-19","2025-08-19","2024-05-29","2025-08-19","2023-11-08","2024-01-08","2025-07-23","2023-07-10","2023-01-05","2023-01-21","2025-06-16","2023-02-15","2025-05-21","2023-05-31","2025-07-23","2024-01-25","2022-11-16","2024-03-20","2025-07-23","2024-06-27","2023-12-12","2025-01-28","2023-01-21","2025-05-30","2024-10-01","2024-10-01","2025-01-03","2024-03-20","2024-03-20","2022-07-01","2022-06-22","2022-06-22","2022-06-10","2022-04-21","2021-10-22","2021-10-15","2021-10-15","2021-11-18"],"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":[["","","OZEMPIC","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","NP THYROID","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PRAZOSIN HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","BENZTROPINE MESYLATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","SHINGRIX","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}