{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marjorie J Morrison","gend":1,"currentgend":"","add":"15 COBB RD","city":"Poland","state":"ME","zip":"04274","dob":"1954-10-31","age":"","mstatus":"","insh":"10000069588","cliId":"","pno":2079984609,"cno":"","email":"polandroadrunner@yahoo.com","ename":"","eno":"","pphy":"SALKO, DAVID L","ppno":2077986200,"pcpadd":"4 HORTON PL,STE. 101","pcpcity":"TOPSHAM","pcpstate":"ME","pcpzip":"40861747","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 COBB RD","madd2":"","madd3":"","mcity":"Poland","mstate":"ME","mzip":"04274","pcpfaxno":2077986290,"pcpnpi":1659338879,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6Y13D73HW97","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B079","D485","M810","L239","L03012","L03011","Z0000","F419","F32A","R42","Z1231","G4700","R32","E119","I10","F418","M62830","R232","M797","E785","Z7689","R7303","R5383","E559","Z09","R6889","G43009"],"date":["2025-04-14","2025-04-14","2023-12-01","2025-04-10","2025-04-10","2025-04-10","2023-07-10","2023-07-10","2023-07-10","2023-07-10","2024-11-29","2024-05-15","2024-04-19","2025-04-29","2025-07-02","2023-10-20","2023-08-24","2024-05-15","2023-03-06","2023-10-20","2023-02-08","2023-10-20","2024-05-15","2024-05-15","2022-09-15","2022-09-15","2022-09-15"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ZOLPIDEM TARTRATE ER","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","TEMAZEPAM","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","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":""}]}]}