{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alice J Young","gend":1,"currentgend":"","add":"51 SCHOOL ST","city":"RANDOLPH","state":"ME","zip":"04346","dob":"1952-09-22","age":"","mstatus":"","insh":"10000086094","cliId":"","pno":2074580364,"cno":"","email":"declined@10112024.com","ename":"","eno":"","pphy":"CHENG, GENE","ppno":2076224400,"pcpadd":"6 Middle St,","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"GENE CHENG MD","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"51 SCHOOL ST","madd2":"","madd3":"","mcity":"RANDOLPH","mstate":"ME","mzip":"04346","pcpfaxno":2076229894,"pcpnpi":1679534770,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3WA5XY3TF63","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","R1012","S61211A","M5450","W1830XA","Z7901","Z1231","M810","Z780","N119","X58XXXA","Y9389","Y929","S62637B","N189","I358","I517","I519","R0789","D122","Z86010","K5730","G4733","F32A","F331","M2011","M79671","S92414K","M79672","I484","K219","R4182","L570","X32XXXA","S0990XA","G930","I6782","N184","L821","L814","Z0000","Z01818","R29890","M47817","M47816","M549","Z4802","D123","S01111A","N12","D649","G479","L03012","R002","S61219A","W3189XA","S22089A","N1832","N179","R112","S62607A","R296","Z0100","R1032","Z01419","E039","N289","L304","I4892","M419","M47814","R1084","N261","L84","M7742","E559","L89159","I10","R110","M5126","N10","R918","L539","M8008XA","L739","I7300","M79675","M79674","K5900","Z043","J320","Z0001","R5383","I4820","Z7682","W268XXA","M4854XA","Z1289","R634","R109","B070","M542","M4802","W293XXA","E162","S96011A","S92414A","R079","Z13820","F3342","I1310","B199","S62637A","S61217A","R6889","N2581","M79605","M8080XA","F419","S99922D","X58XXXD","R7401"],"date":["2024-04-16","2023-09-06","2025-01-15","2024-05-03","2025-05-15","2024-05-03","2025-07-22","2025-08-04","2023-10-02","2025-01-07","2024-09-18","2025-05-15","2024-09-18","2023-07-25","2024-08-06","2023-11-14","2023-11-14","2023-11-14","2023-11-14","2024-08-23","2024-08-23","2024-08-23","2025-11-13","2025-11-13","2025-09-04","2023-05-19","2023-05-19","2023-05-19","2023-05-19","2025-08-20","2024-04-16","2024-04-16","2022-12-14","2022-12-14","2025-05-15","2024-05-03","2024-05-03","2025-09-11","2022-12-14","2022-12-14","2025-10-08","2025-06-17","2024-05-03","2024-05-03","2024-05-03","2024-05-03","2023-07-31","2023-12-12","2025-05-15","2025-05-07","2025-09-11","2024-09-04","2024-10-01","2024-02-29","2023-07-20","2023-07-20","2025-05-24","2025-01-27","2025-01-07","2025-01-27","2023-07-31","2024-12-02","2025-09-12","2023-09-06","2025-10-08","2025-03-25","2025-04-30","2025-03-11","2024-09-27","2025-04-10","2024-05-03","2023-09-06","2023-09-06","2024-02-20","2025-08-18","2024-11-25","2025-02-04","2024-03-08","2024-02-19","2023-09-20","2025-04-10","2024-01-09","2023-05-02","2025-06-27","2025-02-04","2023-03-09","2023-03-09","2023-03-09","2023-09-20","2024-03-23","2024-03-23","2024-11-22","2024-03-23","2024-06-14","2025-09-09","2025-01-15","2025-06-27","2025-10-30","2025-03-25","2024-10-03","2025-08-18","2025-05-15","2025-05-15","2023-07-25","2025-06-24","2023-04-06","2023-04-06","2023-11-14","2023-10-02","2024-11-11","2024-11-11","2025-10-30","2023-07-20","2023-07-20","2023-10-10","2025-09-11","2024-01-05","2023-09-20","2023-03-13","2022-10-10","2022-10-10","2022-09-09"],"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":[["","","BUPROPION XL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","LURASIDONE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","DIGOXIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","GOLYTELY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","FLUCELVAX QUAD 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}