{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ann Marie Ulrich","gend":1,"currentgend":"","add":"377 VARTON RD","city":"WINDSOR","state":"ME","zip":"04363","dob":"1955-10-19","age":"","mstatus":"","insh":"10000079916","cliId":"","pno":2076070048,"cno":"","email":"annmarieulrich@yahoo.com","ename":"","eno":"","pphy":"MILLER, ROY S","ppno":2075497581,"pcpadd":"PO BOX 207,","pcpcity":"COOPERS MILLS","pcpstate":"ME","pcpzip":"43410207","pcpcounty":"","pcpid":"","pcpname":"SHEEPSCOT VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 75","madd2":"","madd3":"","mcity":"WINDSOR","mstate":"ME","mzip":"04363","pcpfaxno":"","pcpnpi":1700854361,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2JU7FN9TT58","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I5181","G459","F321","R079","R6884","F419","Z1231","Z122","I214","C719","E7800","R1013","E785","R030","E039","D329","I499","I219","R4589","I10","I2510","I358","I429","R918","Z0389","M19012","M25512","R531","I2102","D320","I213","L578","M19011","Z7189","G9389","F320","R42","I5189","R002","Z87891","I6523","N390","M25511","Z0000","I5040","I200","R109","R9431","I5021","G2581","Z720","Z8249"],"date":["2023-09-25","2023-12-18","2025-07-17","2025-01-13","2025-01-12","2025-05-09","2023-09-11","2023-05-19","2023-10-04","2023-02-02","2024-01-24","2025-07-28","2023-07-31","2023-07-31","2025-07-28","2025-07-09","2023-06-15","2023-06-12","2025-01-16","2025-07-28","2025-07-28","2023-09-14","2023-09-14","2024-12-30","2023-06-12","2023-06-14","2023-06-15","2023-06-14","2023-06-22","2025-04-04","2023-06-12","2023-04-20","2024-08-28","2023-03-09","2023-12-18","2025-02-20","2025-11-04","2024-03-11","2024-03-11","2023-05-19","2023-12-18","2024-07-25","2024-08-15","2024-11-19","2023-06-13","2023-06-13","2025-07-28","2023-06-14","2023-06-13","2023-06-13","2023-06-12","2023-06-12"],"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":[["","","EZETIMIBE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MINOCYCLINE HCL","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","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":[]}},{"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":""}]}]}