{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth A Keene","gend":1,"currentgend":"","add":"172 LAKE RD","city":"LEVANT","state":"ME","zip":"04456","dob":"1954-02-14","age":"","mstatus":"","insh":"10000071263","cliId":"","pno":2079748877,"cno":"","email":"lizlevant@aol.com","ename":"","eno":"","pphy":"WEINSTEIN, JULIAN J","ppno":2076675899,"pcpadd":"Trenton Health Center,394 Bar Harbor Rd","pcpcity":"Trenton","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"TRENTON HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 219","madd2":"","madd3":"","mcity":"LEVANT","mstate":"ME","mzip":"04456","pcpfaxno":"","pcpnpi":1124686043,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9MD5EC7EK89","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K8064","Z0000","N6489","R92321","I4891","R001","I10","I459","K8012","C50111","C50811","C50911","Z170","Z79811","Z923","Z510","N814","Z853","N6311","Z780","S299XXA","Z48815","Z09","K822","K8050","V2999XA","E669","Z6831","Z713","N812","Z124","N6315","Z1231","Z7722","Z0101","D3132","R928","K8041","K832","R935","R1011","K8020","K838","Z4803","A419","I214","J9601","K750","I454","I493","R748","K8000","C773","K820","Z23","J069","K769","K8070","J90","C221","R079","Z01419","N289","K828","R112"],"date":["2023-12-18","2024-11-05","2024-02-16","2024-02-16","2023-12-29","2023-12-29","2025-03-12","2023-12-29","2023-12-18","2024-10-04","2025-05-12","2024-08-08","2024-11-08","2024-11-08","2024-11-08","2024-07-01","2025-09-25","2025-10-17","2025-04-11","2024-07-23","2024-06-03","2024-01-05","2024-01-02","2024-01-02","2024-01-02","2024-06-03","2023-07-24","2023-07-24","2023-07-24","2023-09-01","2023-09-01","2024-02-26","2024-02-09","2024-05-17","2025-03-11","2025-03-11","2024-02-16","2023-11-03","2023-11-03","2023-11-03","2024-11-21","2023-12-15","2023-12-05","2023-11-15","2023-10-29","2023-11-20","2023-10-29","2023-10-29","2023-12-18","2023-12-18","2024-11-21","2023-12-05","2024-04-16","2023-11-28","2023-11-20","2025-06-05","2023-10-21","2023-10-21","2023-10-24","2023-10-23","2023-10-22","2023-09-01","2023-10-26","2023-10-22","2022-10-08"],"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":[["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","LETROZOLE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}