{
    "version": "0.4",
    "data": [
        {
            "t": "Demographics",
            "q": [
                {
                    "name": "ALAN P BOUCHARD",
                    "gend": 0,
                    "currentgend": "",
                    "add": "339 FRENCH ST APT 308",
                    "city": "MADAWASKA",
                    "state": "ME",
                    "zip": 4756,
                    "dob": "1962-12-23",
                    "age": "",
                    "mstatus": "",
                    "insh": "10000089822",
                    "cliId": "",
                    "pno": 2073166122,
                    "cno": "",
                    "email": "",
                    "ename": "",
                    "eno": "",
                    "pphy": "STOLIKER, TYLER J",
                    "ppno": 2078346140,
                    "pcpadd": "194 E MAIN ST,",
                    "pcpcity": "FORT KENT",
                    "pcpstate": "ME",
                    "pcpzip": 47431428,
                    "pcpcounty": "",
                    "pcpid": "",
                    "pcpname": "MADAWASKA COMMUNITY HEALTH CENTER",
                    "plan": "Martin's Point",
                    "program": "MEDICARE",
                    "lob": "GA - 2025",
                    "region": "",
                    "aligned": "",
                    "ano": "",
                    "add2": "",
                    "add3": "",
                    "madd1": "339 FRENCH ST APT 308",
                    "madd2": "",
                    "madd3": "",
                    "mcity": "MADAWASKA",
                    "mstate": "ME",
                    "mzip": 4756,
                    "pcpfaxno": 2078342967,
                    "pcpnpi": 1417312158,
                    "currentgendcomment": "",
                    "pphycomment": "",
                    "uniqueid": "",
                    "medicareid": "2H94WP9YT62",
                    "medicaidid": "",
                    "pcpFlag": ""
                },
                {
                    "a": {
                        "indx": [
                            "1",
                            "",
                            "",
                            "",
                            "",
                            "",
                            "",
                            ""
                        ],
                        "comment": [
                            "",
                            "",
                            "",
                            "",
                            "",
                            "",
                            "",
                            ""
                        ],
                        "sub": []
                    }
                },
                {
                    "a": []
                },
                {
                    "a": []
                },
                {
                    "a": []
                },
                {
                    "a": []
                }
            ]
        },
        {
            "t": "Previously Documented Conditions",
            "q": [
                {
                    "a": {
                        "diag": [
                            "L03031",
                            "D72829",
                            "I2510",
                            "J189",
                            "S92402A",
                            "S37009A",
                            "M86171",
                            "I4892",
                            "M869",
                            "N179",
                            "I4891",
                            "I10",
                            "I429",
                            "N529",
                            "I081",
                            "R079",
                            "R0602",
                            "R200",
                            "L97519",
                            "R0600",
                            "I110",
                            "J9600",
                            "Z792",
                            "L03115",
                            "S92403A",
                            "Z4802",
                            "E1169",
                            "H5213",
                            "Z0101",
                            "E11621",
                            "E785",
                            "L97509",
                            "F419",
                            "M65331",
                            "M79674",
                            "L989",
                            "S99929A",
                            "M86271",
                            "E11628",
                            "M6530",
                            "Z23",
                            "E13621",
                            "N186",
                            "E039",
                            "F411",
                            "K603",
                            "N189"
                        ],
                        "date": [
                            "2024-10-08",
                            "2023-12-18",
                            "2023-12-14",
                            "2024-10-12",
                            "2025-03-14",
                            "2025-03-23",
                            "2024-10-05",
                            "2023-11-22",
                            "2024-11-07",
                            "2025-03-20",
                            "2025-01-16",
                            "2023-11-22",
                            "2023-11-22",
                            "2023-06-22",
                            "2024-10-16",
                            "2025-03-20",
                            "2025-03-20",
                            "2025-03-20",
                            "2024-09-26",
                            "2025-03-22",
                            "2024-10-16",
                            "2025-03-24",
                            "2024-09-27",
                            "2024-10-06",
                            "2025-03-14",
                            "2024-06-10",
                            "2024-10-10",
                            "2024-04-16",
                            "2024-04-16",
                            "2024-10-03",
                            "2024-09-25",
                            "2024-09-26",
                            "2024-03-19",
                            "2024-05-29",
                            "2024-08-17",
                            "2022-06-07",
                            "2025-03-14",
                            "2024-10-09",
                            "2024-08-17",
                            "2024-04-08",
                            "2023-06-22",
                            "2024-10-29",
                            "2025-03-21",
                            "2022-04-28",
                            "2022-04-14",
                            "2022-04-07",
                            "2022-01-18"
                        ],
                        "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": [
                            [
                                "",
                                "",
                                "GLIMEPIRIDE",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ELIQUIS",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "FUROSEMIDE",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ONETOUCH DELICA PLUS LANCET",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ONETOUCH VERIO TEST STRIP",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ESCITALOPRAM OXALATE",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ONETOUCH ULTRA2",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "AMLODIPINE BESYLATE",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "EZETIMIBE",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "FLUTICASONE PROPIONATE",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ATORVASTATIN CALCIUM",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "LISINOPRIL",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "PANTOPRAZOLE SODIUM",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "METOPROLOL SUCCINATE",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "FLUZONE TRIVALENT 2024-2025",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "SPIKEVAX 2024-2025",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ONETOUCH VERIO FLEX METER",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "AMIODARONE HCL",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "DOXYCYCLINE HYCLATE",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "CEPHALEXIN",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "LEVOTHYROXINE SODIUM",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ONETOUCH ULTRA TEST STRIP",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "AMOXICILLIN-CLAVULANATE POTASS",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "MODERNA COVID BIVAL(6MO UP)EUA",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ISOSORBIDE MONONITRATE ER",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "CYCLOBENZAPRINE HCL",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "FLUZONE QUAD 2023-2024",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "LORAZEPAM",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "LEVOFLOXACIN",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "POTASSIUM CHLORIDE",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "MODERNA COVID (12Y UP)VAC(EUA)",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "SHINGRIX",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "DIAZEPAM",
                                "",
                                "",
                                "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": {
                            "indx": [
                                [
                                    "",
                                    "",
                                    "",
                                    ""
                                ],
                                [],
                                [
                                    ""
                                ],
                                [
                                    ""
                                ],
                                [],
                                [
                                    ""
                                ],
                                [
                                    ""
                                ]
                            ],
                            "comment": [
                                [
                                    "",
                                    "",
                                    "",
                                    ""
                                ],
                                [
                                    ""
                                ],
                                [
                                    ""
                                ],
                                [
                                    ""
                                ],
                                [
                                    ""
                                ]
                            ],
                            "sub": []
                        }
                    }
                },
                {
                    "a": {
                        "indx": [
                            "",
                            "1"
                        ],
                        "comment": [
                            "",
                            ""
                        ],
                        "sub": {
                            "indx": [
                                [
                                    "",
                                    "",
                                    "",
                                    ""
                                ],
                                [],
                                [
                                    ""
                                ],
                                [
                                    ""
                                ],
                                [
                                    ""
                                ],
                                [
                                    ""
                                ],
                                [
                                    ""
                                ],
                                [
                                    ""
                                ]
                            ],
                            "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": ""
                }
            ]
        }
    ]
}