{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dorothy A Campbell","gend":1,"currentgend":"","add":"8 N VILLAGE RD","city":"CAPE NEDDICK","state":"ME","zip":"03902","dob":"1951-06-12","age":"","mstatus":"","insh":"10000082567","cliId":"","pno":2073517666,"cno":"","email":"declined@070224.com","ename":"","eno":"","pphy":"GAUTHIER, MICHAEL N","ppno":2073638430,"pcpadd":"York Family Practice,127 Long Sands Rd Ste 11","pcpcity":"York","pcpstate":"ME","pcpzip":"03909","pcpcounty":"","pcpid":"","pcpname":"YORK FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 N VILLAGE RD","madd2":"","madd3":"","mcity":"CAPE NEDDICK","mstate":"ME","mzip":"03902","pcpfaxno":2073513006,"pcpnpi":1154384485,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3MY8Q22VU63","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J441","Z1231","R739","J9801","J9601","T7840XA","R933","K625","R0902","I10","J449","J9811","G3184","M24574","Z0000","Z4789","R918","Z0101","F03C18","L409","R413","F0390","G319","I672","R0600","I517","M205X1","U071","G300","G309","J4531","R062","E876","M2041","F03C11","F03918","Z859","H05229","R4182","N281","I700","K8020","K5289","F03C0","F918","R0602","R441","F03911","Z23","K5120","D214","E7800","Z20822"],"date":["2025-04-25","2025-10-09","2024-08-22","2023-06-12","2025-11-02","2024-04-25","2024-06-07","2024-06-07","2025-04-20","2025-10-24","2025-10-24","2025-04-25","2025-05-14","2024-02-29","2025-09-05","2024-02-29","2025-06-21","2024-03-21","2025-04-24","2025-10-05","2024-12-05","2025-10-24","2024-12-05","2024-12-05","2025-10-05","2025-10-05","2024-02-07","2023-08-24","2025-04-24","2025-09-05","2025-03-04","2025-04-16","2025-06-23","2024-02-07","2025-04-22","2025-04-24","2025-04-24","2024-04-27","2025-04-24","2024-06-05","2024-06-05","2024-06-05","2024-06-06","2024-12-26","2025-05-24","2023-06-07","2025-04-24","2025-06-21","2025-10-17","2024-06-06","2024-06-06","2022-08-05","2022-06-13"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MEMANTINE HCL ER","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OLANZAPINE ODT","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}