{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy A Violette","gend":1,"currentgend":"","add":"42 POND ST","city":"BUCKSPORT","state":"ME","zip":"04416","dob":"1955-12-28","age":"","mstatus":"","insh":"10000080140","cliId":"","pno":2072663995,"cno":"","email":"nv.violettelane@yahoo.com","ename":"","eno":"","pphy":"WILLEY, SARA","ppno":2074697371,"pcpadd":"Bucksport Regional Health Center,110 Broadway","pcpcity":"Bucksport","pcpstate":"ME","pcpzip":"04416","pcpcounty":"","pcpid":"","pcpname":"BUCKSPORT REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1025","madd2":"","madd3":"","mcity":"BUCKSPORT","mstate":"ME","mzip":"04416","pcpfaxno":2074697306,"pcpnpi":1295101129,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1HJ5G59QN65","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0100","R1030","F4322","R7303","B353","R5383","E785","R6889","J0140","Z780","Z111","M65322","M65331","Z1231","Z1211","K5730","K621","K635","J0180","J0190","H353131","R059","J111","F419","M65332","K6389","Z0000"],"date":["2025-01-27","2023-01-25","2025-06-25","2024-08-21","2023-11-17","2024-01-03","2024-01-03","2023-09-15","2023-12-30","2024-05-22","2025-07-08","2022-10-05","2023-06-07","2025-05-23","2025-07-14","2025-07-14","2025-07-14","2025-07-14","2025-01-27","2022-12-29","2025-08-08","2022-12-29","2022-12-29","2024-08-21","2023-06-07","2025-07-14","2023-08-09"],"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":[["","","ACYCLOVIR","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREMARIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","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":{"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":""}]}]}