{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vickey L Kipfer","gend":1,"currentgend":"","add":"89 MAIN ST","city":"CHERRYFIELD","state":"ME","zip":"04622","dob":"1955-08-04","age":"","mstatus":"","insh":"10000078858","cliId":"","pno":2075988288,"cno":"","email":"VICKEY777@LIVE.COM","ename":"","eno":"","pphy":"STEPHENS, KEVIN W","ppno":2073690146,"pcpadd":"1018 N MOUND ST STE 101,","pcpcity":"NACOGDOCHES","pcpstate":"TX","pcpzip":"75961443","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"89 MAIN ST","madd2":"","madd3":"","mcity":"CHERRYFIELD","mstate":"ME","mzip":"04622","pcpfaxno":2073648626,"pcpnpi":1821046244,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4MU9R07FW11","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T82855A","I2510","I130","I5032","D72829","I25118","I77810","Z955","R079","E876","R9431","I5033","I25110","Z79899","M25511","I083","Z951","J9811","J90","S4991XA","R2232","Z09","E1122","I129","Z01810","M25512","M19012","I25119","Y831","I10","R9439","M7989","M109","N1830","R600","J982","Z4682","J811","Z0000","R0789","G8929","W57XXXA","R0609","E119","I200","Z743","R0600","E785","R5381","G540","M1812","M79642","M19071","L03115","M79671","S99921A","Z6841","E6601","I6523","N1832"],"date":["2023-08-25","2023-10-15","2023-09-18","2023-09-18","2023-09-18","2023-08-22","2023-08-22","2023-08-22","2024-07-15","2023-09-21","2023-08-22","2025-07-29","2023-08-25","2023-11-15","2025-01-07","2023-09-13","2024-06-25","2023-09-16","2023-09-14","2023-07-19","2025-05-06","2023-09-21","2023-09-21","2023-09-21","2023-09-11","2025-04-03","2025-04-03","2023-04-26","2023-04-26","2025-05-16","2024-07-15","2025-05-06","2025-04-03","2023-03-10","2023-08-01","2023-10-10","2023-09-14","2023-09-14","2024-04-08","2024-12-19","2023-08-15","2023-06-06","2023-08-22","2024-09-24","2023-08-23","2023-08-23","2023-08-14","2024-06-25","2023-08-15","2024-11-01","2021-11-16","2021-11-16","2021-11-20","2021-11-20","2021-12-07","2021-12-14","2021-12-16","2021-12-16","2022-01-13","2021-12-14"],"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":[["","","CLOPIDOGREL","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","FREESTYLE TEST STRIPS","","","Select","Select",""],["","","RANOLAZINE ER","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","REPATHA SYRINGE","","","Select","Select",""],["","","FREESTYLE FREEDOM LITE","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","FREESTYLE LITE METER","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}