{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lura R Dolliver","gend":1,"currentgend":"","add":"81 OLD NORWAY DR","city":"BAR HARBOR","state":"ME","zip":"04609","dob":"1945-01-18","age":"","mstatus":"","insh":"10000074822","cliId":"","pno":2072885064,"cno":"","email":"declined@042021.com","ename":"","eno":"","pphy":"CROWELL, LINDA T","ppno":2072888100,"pcpadd":"322 MAIN ST,","pcpcity":"BAR HARBOR","pcpstate":"ME","pcpzip":"46091648","pcpcounty":"","pcpid":"","pcpname":"LISA STEWART WOMENS HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"81 OLD NORWAY DR","madd2":"","madd3":"","mcity":"BAR HARBOR","mstate":"ME","mzip":"04609","pcpfaxno":2072888449,"pcpnpi":1679885263,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4NJ7XC6XP76","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R202","M353","M542","R197","M25552","I10","N390","Z0000","M9904","S336XXD","M7918","H401131","M79672","M5412","M19071","M25512","Z1231","M19072","H401430","H2513","S336XXA","K2289","H6123","H401111","H2511","H2589","R6889","N898","H04123","L989","H401121","D84821","Z780","M159","M79621"],"date":["2024-03-25","2025-09-02","2025-08-06","2024-09-19","2024-02-07","2024-12-12","2022-11-07","2025-06-17","2025-06-30","2025-06-30","2025-06-30","2025-05-13","2025-04-22","2024-04-08","2025-04-22","2024-11-11","2024-02-29","2025-04-22","2025-05-13","2025-05-13","2025-05-28","2022-11-02","2024-03-20","2024-02-12","2024-01-30","2024-04-26","2023-04-02","2022-10-26","2023-04-11","2023-06-29","2024-02-19","2024-12-12","2023-12-05","2024-12-12","2022-08-18"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","VALSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","DORZOLAMIDE HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}