{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth J Walters","gend":1,"currentgend":"","add":"22 WITS END RD","city":"READFIELD","state":"ME","zip":"04355","dob":"1954-11-18","age":"","mstatus":"","insh":"10000072258","cliId":"","pno":2073802639,"cno":"","email":"ewalte54@aol.com","ename":"","eno":"","pphy":"ILYAS, LARA S","ppno":2073772111,"pcpadd":"Rumford Hospital,420 Franklin St","pcpcity":"Rumford","pcpstate":"ME","pcpzip":"04276","pcpcounty":"","pcpid":"","pcpname":"WINTHROP FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 68","madd2":"","madd3":"","mcity":"GARDINER","mstate":"ME","mzip":"04345","pcpfaxno":2076243845,"pcpnpi":1902241425,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7NQ4J43EN71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N6311","H903","Z472","M25552","R928","R0789","Z1231","Z96642","M1612","M2041","M2042","L723","R531","T189XXA","M47812","M4802","M5021","M50221","K5730","D509","Z0000","F419","G4700","Z471","M25511","T84031A","M6281","R600","T84021A","Z98890","E0590","H9193","K449","J320","G379","Z45321","Z4889","Z9621","Z0101","H40013","H9313","Z0001","R799","R0601","R059","Z905","T8484XA","G8918","G629","Z01818","M160","R21","J309"],"date":["2024-06-11","2025-10-07","2024-06-03","2024-06-03","2024-06-11","2024-05-30","2025-08-08","2025-04-23","2024-07-08","2023-05-03","2023-05-15","2024-05-29","2025-05-13","2024-07-17","2025-08-09","2025-08-09","2025-08-09","2025-08-09","2024-06-25","2024-07-16","2024-05-20","2023-08-25","2023-07-20","2024-11-08","2023-08-25","2024-03-25","2024-09-17","2024-03-23","2024-03-23","2024-03-23","2024-08-12","2025-05-12","2024-06-25","2024-08-30","2024-08-30","2024-10-14","2024-10-14","2024-10-14","2023-10-12","2023-10-12","2023-06-26","2025-06-23","2023-06-12","2023-06-12","2023-06-12","2023-05-15","2024-03-25","2024-03-25","2025-05-28","2025-05-29","2024-02-27","2022-11-14","2022-09-26"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":[]}},{"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":""}]}]}