{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Willis Ethridge","gend":0,"currentgend":"","add":"68 PIONEER STREET","city":"WEST PARIS","state":"ME","zip":"04289","dob":"1945-06-10","age":"","mstatus":"","insh":"10000091078","cliId":"","pno":2075767262,"cno":"","email":"Bethridge45@yahoo.com","ename":"","eno":"","pphy":"KENNEY, BRUCE W","ppno":2077952800,"pcpadd":"76 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"POLAND COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"68 PIONEER STREET","madd2":"","madd3":"","mcity":"WEST PARIS","mstate":"ME","mzip":"04289","pcpfaxno":2077952808,"pcpnpi":1629058185,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4GD8CY4PC32","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K5732","I509","Z1211","D123","D124","D125","R9720","L989","I517","C61","J449","H6093","I5032","L309","N400","L821","I2510","I10","I4811","D6489","R55","A09","K8020","K828","K5710","N401","E785","E6601","I499","L409","I119","R7303","R918","R001","Z0000","K635","H401131","H25813","R9389","I081","K838","D649","R5383","L400","Z79899","I480","L570","R109","R1011","H6123","R002","N429","Z23","R197","R399","R519","R9089","G238","I672","U071","D696","Z043","G319"],"date":["2025-04-10","2024-01-30","2023-08-28","2023-08-28","2023-08-28","2023-08-28","2024-12-03","2023-08-07","2024-12-05","2025-07-15","2023-10-19","2023-12-18","2024-09-09","2024-02-26","2024-10-09","2024-02-26","2023-03-21","2025-11-04","2023-03-21","2024-10-30","2024-05-10","2024-03-08","2024-09-19","2024-09-19","2024-09-19","2024-09-19","2023-08-22","2023-08-22","2023-08-22","2024-02-26","2023-10-19","2023-10-19","2022-12-27","2023-01-24","2025-11-11","2023-07-24","2023-08-15","2023-01-17","2023-11-27","2024-12-05","2024-07-12","2024-10-09","2024-10-09","2025-06-03","2024-10-14","2025-07-10","2025-06-03","2024-09-19","2024-04-05","2023-09-18","2022-12-27","2023-11-16","2025-11-11","2024-04-05","2024-06-18","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2025-09-02","2024-07-12","2024-04-28","2024-04-28"],"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":[["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OTEZLA","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","TAZAROTENE","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ACITRETIN","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","LUMIGAN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":[]}},{"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":""}]}]}