{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Helen Belyea","gend":1,"currentgend":"","add":"118 STILLINGER RD","city":"Poland","state":"ME","zip":"04274","dob":"1954-04-08","age":"","mstatus":"","insh":"10000074512","cliId":"","pno":2075762817,"cno":"","email":"ebmikanne5@gmail.com","ename":"","eno":"","pphy":"ALLEN, JOSHUA","ppno":"","pcpadd":"364 MAINE ST,","pcpcity":"POLAND","pcpstate":"ME","pcpzip":"42745109","pcpcounty":"","pcpid":"","pcpname":"POLAND COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"118 STILLINGER RD","madd2":"","madd3":"","mcity":"Poland","mstate":"ME","mzip":"04274","pcpfaxno":2079985756,"pcpnpi":1124686142,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5FQ5E12DN91","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J449","M1710","R0600","Z1212","Z1211","E0500","I4892","R1013","K921","I4891","M1712","L409","R002","R0989","Z0101","H40013","Z09","H524","M25512","Z7689","R600","Z1159","I253","I081","I480","I10","H0520","E079","H04123","I517","K8020","K828","R799","R0609","H35363","H35371","Z0189","Z0000","E669","R252","G4700","Z6832","Z87891","M8580","Z780","Z1231"],"date":["2023-10-31","2023-06-28","2025-10-07","2023-11-29","2023-11-29","2025-09-23","2023-12-07","2023-11-29","2023-11-28","2023-11-28","2023-06-23","2024-07-05","2025-10-07","2025-10-07","2023-11-09","2023-11-09","2023-11-01","2025-09-23","2025-09-10","2023-03-07","2023-04-11","2023-10-24","2024-01-05","2024-01-05","2024-03-18","2024-03-18","2024-08-16","2024-08-20","2024-08-20","2023-04-11","2024-06-26","2024-06-26","2024-06-26","2023-04-11","2022-12-06","2022-12-06","2024-03-22","2023-10-10","2023-10-10","2023-10-10","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-09-12","2022-09-12"],"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":[["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","METHIMAZOLE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","SPIRIVA HANDIHALER","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}