{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joanne L Woods","gend":1,"currentgend":"","add":"535 GREENWOOD RD","city":"PERU","state":"ME","zip":"04290","dob":"1951-03-05","age":"","mstatus":"","insh":"10000079487","cliId":"","pno":2075624216,"cno":"","email":"declined@11212023.com","ename":"","eno":"","pphy":"ALBERT, DEANA C","ppno":2077952800,"pcpadd":"CMMC Family Medicine Residency Program,76 High St Ste 200","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"ELSEMORE DIXFIELD FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"535 GREENWOOD RD","madd2":"","madd3":"","mcity":"PERU","mstate":"ME","mzip":"04290","pcpfaxno":2077952808,"pcpnpi":1578543278,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3R28Y49UV37","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K7689","R600","Z4682","I10","M5450","Z1212","Z1211","R918","R195","K635","K621","K5730","K260","K832","R059","K838","K2090","K3189","Z780","D120","D122","D123","D125","F4381","K839","E1129","R253","F4321","Z23","S3613XD","Z0000","N3941","Z0101","H5201","E119","M8588","A419","S6991XA","M1811","R109","R110","R0602","N10","E1142","N3946","Z1231","R269","R531","E806","E785","K261","K2980","N281","M25532","M810","M19032","M1812","H5211"],"date":["2025-10-09","2025-10-12","2025-10-06","2023-04-17","2025-08-07","2024-01-01","2024-02-22","2025-10-08","2024-02-22","2024-02-22","2024-02-22","2025-10-05","2025-10-09","2025-10-06","2023-12-28","2025-10-06","2025-10-06","2025-10-06","2025-05-28","2024-02-22","2024-02-22","2024-02-22","2024-02-22","2025-09-22","2025-10-06","2023-11-15","2025-11-12","2023-11-15","2024-12-16","2025-11-07","2024-12-16","2025-09-17","2024-10-02","2024-10-02","2024-10-02","2025-05-28","2025-10-05","2023-08-16","2023-08-16","2025-10-05","2025-10-05","2025-10-02","2025-10-02","2024-05-22","2025-06-17","2024-10-22","2025-11-06","2025-10-02","2023-02-27","2023-02-24","2025-10-05","2025-10-05","2025-10-05","2022-11-10","2022-10-06","2022-10-06","2022-09-16","2022-04-26"],"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":[["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","TOLTERODINE TARTRATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CHOLESTYRAMINE LIGHT","","","Select","Select",""],["","","TEMAZEPAM","","","Select","Select",""],["","","ACCU-CHEK SOFTCLIX","","","Select","Select",""],["","","ACCU-CHEK GUIDE TEST STRIP","","","Select","Select",""],["","","ACCU-CHEK GUIDE MONITOR SYSTEM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","PREVALITE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}