{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Laurie J Hall","gend":1,"currentgend":"","add":"28 RIM RD","city":"MILBRIDGE","state":"ME","zip":"04658","dob":"1961-09-13","age":"","mstatus":"","insh":"10000090512","cliId":"","pno":2075988727,"cno":"","email":"declined@022422.com","ename":"","eno":"","pphy":"BARBEE, KRISTEN","ppno":2075462391,"pcpadd":"ONE MEDICAL CENTER DRIVE,","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"04005","pcpcounty":"","pcpid":"","pcpname":"MILBRIDGE MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 RIM RD","madd2":"","madd3":"","mcity":"MILBRIDGE","mstate":"ME","mzip":"04658","pcpfaxno":2072846291,"pcpnpi":1215166533,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7C41XF3JG90","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1231","E119","C8510","C8331","Z5111","C8330","C9110","R6884","Z5112","M5450","M79604","M79605","Z0000","Z23","I10","C8518","Z79899","G4730","C83398","C8519","Z0101","H524","B3731","R300","E785","G4733","R519","R590","Z510","Z452","C8300","Z01810","I5030","I67848","R4182","R221","Z01818","Z20822","N814","J0190","G4701","I499","Z0001","Z5181","D759","R197","Z923","H40053","M25551","E876","M7989","R399","H2513","R0600","R220","J329","C8511","D696","Z79624","E042","D649","H04123","M25559","R161","Z9221","N390","J069","M9903","S335XXA","M9904","M5136","M25561"],"date":["2025-05-20","2025-05-09","2025-08-15","2025-06-18","2025-03-17","2025-04-18","2025-04-09","2025-08-06","2025-03-19","2025-09-09","2025-09-09","2025-09-09","2024-11-22","2023-10-10","2024-04-12","2025-01-29","2025-01-29","2023-10-10","2025-01-22","2025-01-22","2023-10-27","2023-10-27","2024-03-08","2024-06-27","2024-04-12","2025-09-25","2025-04-25","2024-05-30","2025-03-03","2025-02-26","2025-01-24","2024-07-30","2024-08-14","2025-03-28","2025-03-26","2024-06-27","2025-03-27","2025-03-20","2024-04-12","2025-05-15","2024-05-01","2023-06-28","2023-10-10","2025-01-10","2025-08-07","2025-07-16","2025-07-16","2025-08-21","2023-11-13","2024-12-02","2025-08-06","2024-12-20","2025-02-21","2023-06-28","2024-06-07","2023-12-27","2025-06-06","2025-06-06","2025-06-06","2024-06-20","2024-12-02","2025-02-21","2023-11-13","2025-04-25","2025-04-25","2022-09-13","2022-06-07","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-03-30"],"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":[["","","FLUCELVAX QUAD 2022-2023","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","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":""}]}]}