{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah L Godin","gend":1,"currentgend":"","add":"151 MADISON AVE","city":"SKOWHEGAN","state":"ME","zip":"04976","dob":"1953-05-19","age":"","mstatus":"","insh":"10000090782","cliId":"","pno":2074311971,"cno":"","email":"NONE@NONE.COM","ename":"","eno":"","pphy":"DICRANIAN, WENDY R","ppno":2078584844,"pcpadd":"PO BOX 468,","pcpcity":"SKOWHEGAN","pcpstate":"ME","pcpzip":"49760468","pcpcounty":"","pcpid":"","pcpname":"SOMERSET PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"151 MADISON AVE","madd2":"","madd3":"","mcity":"SKOWHEGAN","mstate":"ME","mzip":"04976","pcpfaxno":2078580348,"pcpnpi":1447287883,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5DX6V82YM85","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R413","M436","G4733","R928","N6489","M25561","Z471","Z96651","I6782","G319","J984","R918","R519","R0789","M5416","Z0000","R079","G5781","R404","G43909","R0602","F418","H0011","H00024","M85851","Z780","M25562","F39","M85861","J449","R0600","Z1231","Z23","E8310","S0083XA","R232","S4991XA","R1011","R109","R200","R202","E785","G43109","Z0101","N952","H40013","Z0100","R92331","H2513","G43B0","H04123","H527","N390","Z1283","L821","L570","R4189","Z87891","R911","G629","G4731","G4710","R0683","H524","U071","U099","R42","R059","K820","I700","R932","R5383","I471"],"date":["2025-06-20","2022-12-01","2024-05-15","2025-09-29","2025-02-12","2025-09-19","2023-03-13","2023-04-24","2025-10-22","2025-10-22","2023-03-16","2023-03-16","2024-11-19","2025-08-29","2024-10-22","2024-02-12","2024-07-18","2023-03-21","2025-08-05","2025-02-14","2024-12-12","2024-11-14","2025-10-21","2025-10-21","2023-02-09","2023-02-09","2023-04-20","2023-09-06","2023-02-09","2023-03-06","2023-03-06","2024-01-22","2023-10-19","2025-11-05","2023-07-27","2023-05-12","2024-04-25","2023-06-01","2023-06-01","2025-03-31","2025-03-31","2025-02-27","2025-04-16","2024-01-26","2024-01-22","2025-05-12","2023-07-31","2024-02-05","2025-05-12","2025-05-12","2025-05-12","2025-05-12","2024-03-27","2023-04-24","2023-04-24","2023-04-24","2025-02-27","2025-02-27","2023-03-16","2025-02-26","2022-11-02","2022-11-02","2022-11-02","2022-10-19","2022-09-22","2022-09-22","2022-08-08","2022-09-02","2022-08-25","2022-08-25","2022-08-25","2022-08-24","2022-08-01"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","BRIVIACT","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","AZELAIC ACID","","","Select","Select",""],["","","CARISOPRODOL","","","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":[]}},{"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":""}]}]}