{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vivian A Crocker","gend":1,"currentgend":"","add":"686 MAIN ST","city":"HARTFORD","state":"ME","zip":"04220","dob":"1953-09-29","age":"","mstatus":"","insh":"10000075968","cliId":"","pno":2075972548,"cno":"","email":"DECLINED@05312024.COM","ename":"","eno":"","pphy":"RIVARD, GARY S","ppno":2075243501,"pcpadd":"180 CHURCH HILL RD,STE 1","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"686 MAIN ST","madd2":"","madd3":"","mcity":"HARTFORD","mstate":"ME","mzip":"04220","pcpfaxno":2076476015,"pcpnpi":1194801993,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2JY0HH8GQ39","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","R079","M549","I69151","I2510","I255","J9811","E039","E1165","I639","M47816","I69351","M5450","G8929","M7918","E113311","R4182","E1121","H43823","M5451","E113392","H26493","N390","N179","E119","E113211","I6523","M1611","M4727","E109","M2141","M2142","Z9189","I5040","R0600","M25551","M25552","E785","I429","S1087XA","I739","I70212","E162","M9901","M9902","M9903","R5383","M542","I70202"],"date":["2025-10-27","2025-09-10","2025-07-24","2025-09-04","2025-09-10","2023-03-21","2025-07-24","2025-10-27","2025-03-19","2025-09-10","2024-03-26","2025-07-29","2024-04-25","2024-04-25","2024-04-25","2024-11-07","2025-07-24","2023-05-04","2023-06-19","2023-06-21","2024-08-01","2023-04-24","2025-07-25","2025-07-25","2025-07-25","2025-09-03","2025-07-25","2023-10-24","2023-10-24","2025-04-08","2023-07-25","2023-07-25","2025-10-24","2025-05-27","2025-05-27","2023-10-24","2023-10-24","2025-05-13","2025-09-10","2022-08-23","2022-06-29","2022-06-29","2022-05-25","2022-05-04","2022-05-04","2022-05-04","2022-04-21","2022-04-05","2022-03-31"],"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":[["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY READER","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FIASP FLEXTOUCH","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CILOSTAZOL","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"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":""}]}]}