{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Evelyn D Girard","gend":1,"currentgend":"","add":"246 POND RD 14A","city":"BRIDGTON","state":"ME","zip":"04009","dob":"1942-04-05","age":"","mstatus":"","insh":"10000073309","cliId":"","pno":2072299683,"cno":"","email":"declined@102425.com","ename":"","eno":"","pphy":"JOLICOEUR, MYRIAM","ppno":2076936106,"pcpadd":"76 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"NAPLES FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"246 POND RD 14A","madd2":"","madd3":"","mcity":"BRIDGTON","mstate":"ME","mzip":"04009","pcpfaxno":2076934026,"pcpnpi":1316433667,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3X44M29GD85","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R21","B351","E1159","M7989","L03115","L84","K3580","I4891","I10","K429","I2510","K37","L0390","E039","D7589","L304","Z09","R600","I161","E1169","R2689","K130","Z01810","R609","L03119","F4321","E119","K3533","N898","K047","R1031","Z0101","Z0000","L89309","L8990","E1151","E785","Z1321"],"date":["2024-12-19","2025-10-07","2025-10-07","2024-10-10","2024-10-05","2025-10-07","2025-09-29","2025-09-18","2025-09-18","2025-09-18","2025-10-29","2025-10-02","2024-10-21","2023-09-19","2025-04-23","2025-01-15","2025-01-24","2024-10-29","2025-01-22","2025-05-09","2025-03-03","2023-01-04","2025-09-19","2025-06-18","2024-09-30","2024-04-11","2023-04-13","2025-09-18","2024-12-31","2024-12-03","2025-09-17","2025-03-04","2023-09-27","2022-11-16","2022-11-18","2022-10-20","2022-09-26","2022-09-13"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","TRUE METRIX BLOOD GLUCOSE MTR","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}