{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beth B Libby Farrell","gend":1,"currentgend":"","add":"121 PEMAQUID LOOP RD","city":"NEW HARBOR","state":"ME","zip":"04554","dob":"1950-07-10","age":"","mstatus":"","insh":"10000087966","cliId":"","pno":2076772258,"cno":2075765560,"email":"graywolf1947@gmail.com","ename":"","eno":"","pphy":"GOLTZ, TIMOTHY T","ppno":2075634250,"pcpadd":"24 MILES CENTER WAY,","pcpcity":"DAMARISCOTTA","pcpstate":"ME","pcpzip":"45434047","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"121 PEMAQUID LOOP RD","madd2":"","madd3":"","mcity":"NEW HARBOR","mstate":"ME","mzip":"04554","pcpfaxno":2075634246,"pcpnpi":1245226869,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1TU0WN4NN44","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S62610A","I4891","E119","I10","E785","E039","E1165","Z23","I5021","I083","I2720","Z4789","S6721XA","Z4889","R918","I509","F419","Z1211","Z01818","Z98890","Z0000","I080","I480","I110","I252","Z1231","W230XXA","J45909","R000","R0602","I214","I2510","R931","H26493","H02834","H02831"],"date":["2023-08-09","2024-03-08","2025-06-16","2024-01-22","2025-08-01","2025-08-01","2025-03-07","2025-06-16","2024-04-15","2024-01-23","2024-01-19","2023-08-09","2023-11-01","2023-09-26","2024-01-18","2024-01-23","2024-01-18","2025-08-01","2023-08-08","2023-11-02","2024-08-14","2024-04-15","2025-09-30","2024-01-20","2024-04-01","2025-03-13","2023-08-09","2025-08-01","2024-01-19","2024-01-19","2024-01-22","2024-01-22","2024-01-22","2023-10-03","2022-06-15","2022-08-03"],"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":[["","","TORSEMIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","SYNJARDY XR","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OXYCODONE HCL","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}