{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Theresa M Drury","gend":1,"currentgend":"","add":"12 BROWN HILL RD","city":"PERU","state":"ME","zip":"04290","dob":"1957-01-31","age":"","mstatus":"","insh":"10000092336","cliId":"","pno":2075627358,"cno":2072408553,"email":"mcdru3@gmail.com","ename":"","eno":"","pphy":"KING, JESSICA S","ppno":2075624226,"pcpadd":"Elsemore Dixfield Family Medicine,146 Weld St","pcpcity":"Dixfield","pcpstate":"ME","pcpzip":"04224","pcpcounty":"","pcpid":"","pcpname":"ELSEMORE DIXFIELD FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 BROWN HILL RD","madd2":"","madd3":"","mcity":"PERU","mstate":"ME","mzip":"04290","pcpfaxno":5188242388,"pcpnpi":1649615923,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2NH6Y54FW82","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1231","M25552","R92331","N6489","M8589","F419","R6889","N6011","Z0000","Z136","R141","Z0101","H5213","M546","L570","L718","L821","D225","L814","Z1211","M5450","M25512","N6002","R928","R922","H43811"],"date":["2025-02-20","2024-06-26","2025-08-25","2025-08-25","2025-02-20","2025-07-17","2022-01-05","2025-08-25","2025-01-13","2025-02-20","2023-06-08","2025-05-05","2025-05-05","2024-07-01","2025-07-09","2024-07-09","2025-07-09","2025-07-09","2025-07-09","2024-02-02","2024-06-26","2025-11-06","2022-12-15","2022-12-15","2022-12-15","2022-09-27"],"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":[["","","PAROXETINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}