{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elaine J Ladd","gend":1,"currentgend":"","add":"20 DR HAM RD","city":"READFIELD","state":"ME","zip":"04355","dob":"1953-11-23","age":"","mstatus":"","insh":"10000062313","cliId":"","pno":2074581001,"cno":"","email":"unicorn1953@gmail.com","ename":"","eno":"","pphy":"HARMON, KELLEY J","ppno":2078615000,"pcpadd":"15 E CHESTNUT ST,","pcpcity":"AUGUSTA","pcpstate":"ME","pcpzip":"43305736","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICINE INSTITUTE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 119","madd2":"","madd3":"","mcity":"READFIELD","mstate":"ME","mzip":"04355","pcpfaxno":2076261849,"pcpnpi":1578670733,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5AP6G75KP51","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","M25531","H73891","E119","I10","Z7984","M25551","M25552","R5383","M19031","M160","R051","R300","E785","Z0101","K219","R059","R011","M5431","R42","N951","M5450","D72829","R053","Z972","R079","Z01419","R232"],"date":["2025-04-09","2025-09-17","2023-03-18","2025-08-22","2025-09-08","2024-09-18","2025-08-22","2025-08-22","2025-09-08","2025-09-17","2025-09-17","2025-09-17","2024-03-08","2024-03-08","2025-05-07","2023-03-21","2023-03-21","2025-09-08","2023-01-24","2023-01-24","2023-01-24","2023-02-20","2024-06-05","2023-03-18","2023-03-18","2022-08-10","2022-08-10","2022-08-10"],"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":[["","","AZITHROMYCIN","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","DEXCOM G6 RECEIVER","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","JANUVIA","","","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":""}]}]}