{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sally D Joy","gend":1,"currentgend":"","add":"22 SMITHFIELD DR","city":"Machias","state":"ME","zip":"04654","dob":"1956-05-31","age":"","mstatus":"","insh":"10000086685","cliId":"","pno":"","cno":2072142438,"email":"joy_sally@hotmail.com","ename":"","eno":"","pphy":"RIOUX, DAVID C","ppno":2072553356,"pcpadd":"11 HOSPITAL DR,","pcpcity":"MACHIAS","pcpstate":"ME","pcpzip":"46543325","pcpcounty":"","pcpid":"","pcpname":"DOWN EAST COMMUNITY HOSPITAL MEDICAL ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"22 SMITHFIELD DR","madd2":"","madd3":"","mcity":"Machias","mstate":"ME","mzip":"04654","pcpfaxno":2072550705,"pcpnpi":1316084650,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1G96KE7CA60","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5416","M5136","M461","M47816","Z0000","I10","R7303","M48061","R300","M5459","M9903","M546","M9902","E119","F418","M48062","R29898","M160","L570","M5116","R102","G8929","M5450","M533","M5451","H2512","H2511","M7918","H2513","M5126","E7800","Z1231","Z13820","Z780","E039","J40","Z961","Z23","R251","E669","H538","R6889","M5417","J209"],"date":["2025-05-28","2023-03-13","2024-12-20","2024-07-18","2025-03-04","2024-10-22","2023-05-22","2022-10-11","2023-02-27","2023-05-05","2023-05-05","2023-05-05","2023-05-05","2025-01-10","2024-10-22","2023-07-24","2023-02-09","2025-07-23","2024-06-24","2023-07-24","2023-02-27","2023-03-24","2023-03-24","2023-07-24","2023-03-21","2023-09-27","2023-09-18","2025-04-14","2023-07-27","2023-03-13","2023-03-21","2025-04-08","2025-04-08","2025-04-08","2024-06-24","2023-12-19","2023-11-09","2022-09-13","2022-09-13","2022-09-13","2022-07-18","2022-07-18","2022-07-29","2022-06-14"],"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":[["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","ULTRA-FINE MICRO PEN NEEDLE","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}