{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alice T Wilson","gend":1,"currentgend":"","add":"337 MITCHELL RD","city":"CAPE ELIZ","state":"ME","zip":"04107","dob":"1942-05-27","age":"","mstatus":"","insh":"10000082948","cliId":"","pno":2077992310,"cno":"","email":"declined@10102023.com","ename":"","eno":"","pphy":"HASKELL, ERIC S","ppno":2077672174,"pcpadd":"301C US ROUTE 1,","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40749701","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"337 MITCHELL RD","madd2":"","madd3":"","mcity":"CAPE ELIZ","mstate":"ME","mzip":"04107","pcpfaxno":2073968632,"pcpnpi":1770742439,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6JP8U61TY68","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G250","H2512","R310","N898","I480","H2511","R9431","J40","I4710","R6889","Z0000","Z9181","D6869","Z01812","R079","M5440","M6281","H109","R6330","L820","L570","L719","L814","U071","Z780","N1831","D259","R319","Z1231","N952","L900","Z803","R102","R059","R001","R5383","H35363","H35373","Z0100","E039","H259","R300","Z23","D6859","K635","K625","K5730","K648","R1900","K222","H35372","K219","K449","H2513","Z13228","Z130","Z13220","L821","D1801","K921","J479","M85852","Z961","Z8701","N1832","D122","R1310","K2100","R519","I4891","E668","Z6830","N763","S61451A","W540XXA","K068","B351"],"date":["2023-01-20","2023-09-06","2023-06-07","2025-07-08","2025-11-11","2023-06-06","2023-12-05","2024-05-08","2024-06-07","2023-09-06","2025-01-13","2023-09-22","2023-09-22","2025-08-18","2024-05-16","2023-11-16","2023-11-16","2024-05-08","2023-01-20","2023-10-06","2024-10-11","2025-10-17","2023-10-06","2023-03-24","2023-12-26","2023-12-29","2025-09-26","2023-06-22","2025-07-22","2025-09-24","2025-09-24","2023-09-21","2025-07-25","2024-05-15","2024-05-15","2024-05-15","2025-09-23","2024-09-10","2025-09-23","2025-01-15","2023-05-10","2023-08-24","2025-09-24","2023-04-28","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2025-09-26","2023-08-01","2023-03-10","2023-08-01","2023-08-01","2023-03-10","2025-01-15","2025-01-15","2025-01-15","2025-10-17","2025-10-17","2023-03-15","2024-05-03","2024-10-23","2023-09-06","2024-05-08","2025-11-11","2023-08-01","2023-08-01","2022-11-07","2022-11-18","2022-09-28","2022-08-22","2022-08-22","2022-08-22","2022-08-11","2022-08-11","2022-08-08","2022-08-08"],"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":[["","","XARELTO","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","IVERMECTIN","","","Select","Select",""],["","","FLECAINIDE ACETATE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","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":[]}},{"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":""}]}]}