{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Amanda B Hunter","gend":1,"currentgend":"","add":"10 OLE MUSKET RD APT 4","city":"CUMBERLAND FORESIDE","state":"ME","zip":"04110","dob":"1957-01-02","age":"","mstatus":"","insh":"10000091955","cliId":"","pno":2077815512,"cno":"","email":"","ename":"","eno":"","pphy":"MARTIN, STEPHEN","ppno":2078469013,"pcpadd":"Intermed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 OLE MUSKET RD APT 4","madd2":"","madd3":"","mcity":"CUMBERLAND FORESIDE","mstate":"ME","mzip":"04110","pcpfaxno":2078741483,"pcpnpi":1740249861,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6D10C19KF14","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F4323","R300","R7303","R928","K5732","N390","E7800","R053","Z0101","M160","Z23","R051","Z713","Z0000","L821","D1801","L578","D225","J329","M1611","M25559","F5101","F411","U071","L03012","Z1231","M25551","Z0001","R5383","J069","I10","R6889","I700","Z808","R059","N6489","H35443","H2513","K5792","Z806","D485","L918"],"date":["2023-11-02","2023-11-10","2025-08-14","2025-01-30","2024-04-24","2023-11-10","2023-05-16","2024-01-11","2024-11-20","2025-10-21","2025-09-16","2024-01-04","2025-08-14","2024-05-20","2024-01-16","2023-01-12","2024-01-16","2024-01-16","2023-06-28","2025-10-21","2025-10-21","2023-12-11","2023-12-11","2023-12-11","2024-11-26","2025-01-15","2025-10-21","2025-06-05","2025-05-26","2025-05-26","2025-06-17","2023-03-21","2024-05-23","2024-01-16","2024-05-14","2025-01-30","2022-10-13","2022-10-13","2022-05-29","2022-05-16","2022-01-10","2022-01-10"],"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":[["","","ESZOPICLONE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","VALSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":""}]}]}