{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan Abbott","gend":1,"currentgend":"","add":"6 MABRY LN","city":"KENNEBUNK","state":"ME","zip":"04043","dob":"1955-10-28","age":"","mstatus":"","insh":"10000092603","cliId":"","pno":2078384766,"cno":"","email":"","ename":"","eno":"","pphy":"COTE, JEFFREY T","ppno":2076460676,"pcpadd":"Wells Family Practice,59 Mile Rd","pcpcity":"Wells","pcpstate":"ME","pcpzip":"04090","pcpcounty":"","pcpid":"","pcpname":"WELLS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"6 MABRY LN","madd2":"","madd3":"","mcity":"KENNEBUNK","mstate":"ME","mzip":"04043","pcpfaxno":2076466513,"pcpnpi":1467544668,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6F17AD5ED32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N950","N858","Z0100","R55","E7800","I10","N6321","N281","N390","S76011A","M25651","Z0000","Z1231","R002","L821","L814","D1801","D224","L570","D492","C44319","C44529","C44622","H2513","I493","R0609","J069","M25551","L820","H8110","R9389","J029","Z20818","Z23","R079","Z72820","H34231","R0789","I6523","H34239","Z7189","E785","D122","Z1331","Z860101","K5730","K219","K222","J209","I471","Z20822","H35371","D3121","R9431","H25813","K529","R1310","D72819","H25811","H43813"],"date":["2024-01-04","2023-09-22","2023-03-20","2023-07-24","2025-07-17","2025-07-17","2025-01-22","2024-03-10","2024-07-08","2023-05-30","2023-05-30","2024-12-05","2025-01-16","2025-11-12","2025-10-07","2025-10-07","2025-10-07","2025-10-07","2025-10-07","2025-10-07","2025-10-30","2025-10-30","2025-10-30","2024-06-28","2025-09-17","2023-02-16","2023-02-16","2023-02-16","2023-10-27","2025-01-28","2024-01-04","2023-01-02","2022-12-29","2022-12-29","2025-11-05","2023-06-11","2024-02-13","2023-07-25","2024-01-16","2024-01-16","2024-12-05","2023-07-12","2024-10-23","2024-12-05","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2023-11-07","2023-07-29","2023-01-02","2024-02-13","2024-02-13","2023-06-07","2025-08-28","2023-07-14","2023-07-14","2022-09-14","2022-08-12","2022-08-31"],"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":[["","","MESALAMINE ER","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","KLOR-CON M20","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}