{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ellen K Marston","gend":1,"currentgend":"","add":"128 FIRST ST","city":"WEST GARDINER","state":"ME","zip":"04345","dob":"1955-02-14","age":"","mstatus":"","insh":"10000076365","cliId":"","pno":2074621672,"cno":"","email":"declined@062225.com","ename":"","eno":"","pphy":"LIEGNER, ADAM","ppno":2075826608,"pcpadd":"4 HORTON PL,SUITE 101","pcpcity":"TOPSHAM","pcpstate":"ME","pcpzip":"40861747","pcpcounty":"","pcpid":"","pcpname":"GARDINER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"128 FIRST ST","madd2":"","madd3":"","mcity":"WEST GARDINER","mstate":"ME","mzip":"04345","pcpfaxno":2075822258,"pcpnpi":1265793574,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9P02K41JK17","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","R079","Z7722","Z579","R059","T63441A","I318","R0602","R21","Z0279","I10","Z9989","H209","M25561","N6310","N6320","I739","Z1211","M1711","H04123","H16142","J45909","L500","R0609","T7849XA","Z91030","R0600","S298XXA","W010XXA","D120","D123","M47816","M4316","M5137","M5450","K219","Z7951","R051","L259","E039","Z79899","K449","K317","L255","Z13820","N644","H10213","H11142","H1045","Z0100","K3189","J309","R12","K760","J9811","N6315","N6325","R1013","R928","Z23","Z780","R0989","R0981","R202","B029","R0789","T478X5A","S1096XA","W57XXXA","T148XXA","L918"],"date":["2025-10-17","2025-03-03","2025-05-08","2025-01-30","2025-10-24","2025-08-13","2025-03-03","2025-04-30","2025-10-24","2023-02-13","2025-02-17","2023-02-13","2025-08-13","2024-01-24","2024-10-16","2024-10-16","2024-02-27","2023-01-26","2023-12-27","2025-09-29","2025-09-29","2025-05-08","2023-07-18","2025-02-17","2023-07-18","2023-07-18","2025-02-17","2025-01-17","2025-01-17","2023-01-26","2023-01-26","2023-11-09","2023-11-09","2023-11-09","2023-11-09","2025-05-08","2025-05-08","2025-01-06","2025-01-06","2025-01-30","2025-04-30","2024-01-03","2024-01-03","2023-08-28","2025-08-15","2024-10-08","2025-08-28","2025-08-28","2025-08-28","2025-03-19","2024-01-03","2024-02-26","2024-01-03","2025-01-30","2025-01-30","2024-10-16","2024-10-16","2023-06-26","2024-10-16","2023-12-27","2025-08-15","2023-10-30","2025-10-24","2025-05-06","2025-04-25","2025-01-30","2024-01-03","2022-11-22","2022-11-22","2022-11-08","2022-11-22"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","OLOPATADINE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}