{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan F Whipple","gend":1,"currentgend":"","add":"184 PATTERSON RD","city":"Hampden","state":"ME","zip":"04444","dob":"1953-02-08","age":"","mstatus":"","insh":"10000082048","cliId":"","pno":2078624064,"cno":2075929627,"email":"hampdensue@gmail.com","ename":"","eno":"","pphy":"MOODY, LAUREN M","ppno":2072230965,"pcpadd":"Winterport Community Health Center,775 N Main St","pcpcity":"Winterport","pcpstate":"ME","pcpzip":"04496","pcpcounty":"","pcpid":"","pcpname":"PENOBSCOT COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"184 PATTERSON RD","madd2":"","madd3":"","mcity":"Hampden","mstate":"ME","mzip":"04444","pcpfaxno":2072230975,"pcpnpi":1356902605,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1QC2WH0UV06","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J849","R911","R0602","R32","Z1211","Z86010","K640","K621","N1831","E785","F319","M8588","Z1231","Z780","E559","Z79899","R7309","I10","R000","R6889","D123","R4189","G459","N8110","H6991","H903","N816","N393","Z9851","F1120","Z0000","M79672","M722","Z0101","E7800","Z8673","H9319","H938X3","Z974","F900","I639","I6782","I4891","N812","H6123","R946","I69398","Z7982","R151","R4701","M19072","N1830","H35371","Z1151","Z01419","Z124","N898","N814"],"date":["2024-04-18","2024-04-18","2023-04-12","2024-11-21","2023-03-16","2023-03-16","2023-03-16","2023-03-16","2024-11-15","2024-11-15","2025-08-06","2024-05-08","2025-05-09","2024-05-08","2023-09-27","2025-09-04","2024-09-13","2025-08-19","2023-09-29","2023-06-23","2023-03-16","2024-12-12","2023-08-28","2023-09-12","2023-10-23","2024-12-04","2024-10-15","2023-09-12","2023-09-12","2024-05-16","2023-09-21","2025-04-02","2025-04-02","2025-03-06","2022-11-11","2024-09-04","2024-11-11","2024-11-11","2024-11-11","2023-07-06","2023-05-09","2023-05-10","2023-05-10","2024-10-15","2025-04-16","2024-01-30","2024-02-13","2024-02-13","2023-02-27","2024-04-22","2025-03-07","2023-08-08","2025-03-06","2022-08-23","2022-08-23","2022-08-23","2022-08-23","2022-06-28"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","METHYLPHENIDATE HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}