{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dawn E Stewart","gend":1,"currentgend":"","add":"8 KATAHDIN AVE","city":"MILLINOCKET","state":"ME","zip":"04462","dob":"1954-12-01","age":"","mstatus":"","insh":"10000062765","cliId":"","pno":2072611349,"cno":2074478035,"email":"60daydawn@gmail.com","ename":"","eno":"","pphy":"AQUILINA, JOSEPH","ppno":2072230965,"pcpadd":"PO BOX 99,","pcpcity":"LINCOLN","pcpstate":"ME","pcpzip":"44570099","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 KATAHDIN AVE","madd2":"","madd3":"","mcity":"MILLINOCKET","mstate":"ME","mzip":"04462","pcpfaxno":2077946777,"pcpnpi":1104835669,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4CV7QA2WR20","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K219","M5450","S3991XA","S3993XA","M9903","M9904","M9905","M160","M65251","S76011A","W07XXXA","S3992XA","Z0000","M533","R6889","R1310","Z1231","K2950","K31A0","I509","Z13220","Z1329","Z9884","K449","S46211A","X58XXXA","J441","F331","F32A","H35363","H26491","H04123","M25511","M25551","Z48815","I10","K661","J45909","M1611","D510","M810","J40","D62","E7800","I82409","M461","M25562","L4050","Z87891","Z800","F411","M19011","Z09","R2242","M25522","M25521","R5383","F330"],"date":["2023-04-13","2024-04-23","2023-11-25","2023-11-25","2024-02-13","2024-02-13","2024-02-13","2024-03-08","2024-03-08","2024-03-08","2024-03-08","2023-11-25","2025-06-30","2023-11-27","2023-11-12","2023-04-13","2025-03-20","2023-04-13","2023-04-13","2025-06-30","2025-06-30","2025-06-30","2023-04-13","2023-08-02","2023-07-28","2023-07-28","2023-01-19","2023-01-05","2023-08-07","2023-07-24","2023-07-24","2023-07-24","2023-07-18","2024-05-02","2023-08-16","2024-06-10","2023-08-02","2023-06-26","2024-02-28","2024-06-10","2023-11-13","2023-03-21","2023-08-02","2023-08-02","2024-06-01","2024-02-26","2024-06-03","2024-12-30","2023-03-28","2023-03-28","2025-08-04","2023-05-31","2024-06-10","2024-06-03","2023-05-31","2023-05-31","2024-06-10","2024-06-10"],"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":[["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","SPIRIVA HANDIHALER","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OXYCODONE HCL","","","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":""}]}]}