{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vivian A Jones","gend":1,"currentgend":"","add":"329 E BUCKFIELD RD","city":"BUCKFIELD","state":"ME","zip":"04220","dob":"1956-02-05","age":"","mstatus":"","insh":"10000092662","cliId":"","pno":2078909630,"cno":"","email":"","ename":"","eno":"","pphy":"RIVARD, GARY S","ppno":2075243501,"pcpadd":"180 CHURCH HILL RD,STE 1","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"329 E BUCKFIELD RD","madd2":"","madd3":"","mcity":"BUCKFIELD","mstate":"ME","mzip":"04220","pcpfaxno":2076476015,"pcpnpi":1194801993,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1MU4AF4HX82","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1165","M9902","S46012A","M549","M79602","E785","Z1231","M65332","M65342","Z1239","B372","M65341","R921","R92311","M65351","M65311","M179","M65331","E119","N390","R059","R202","I10","Z0000","M1711","M25561","R52","E113291","Z0101","D3131","H25813","G629","M5416","R319","R922","R350","Z1211","D123","K5730","K640","Z86010","E113392","Z780"],"date":["2024-10-30","2024-10-24","2024-10-24","2024-10-24","2024-10-24","2024-10-30","2023-09-22","2024-03-07","2024-03-07","2024-01-08","2022-11-29","2023-04-27","2024-07-08","2024-01-08","2024-10-01","2024-10-01","2024-07-31","2023-08-01","2024-10-23","2022-12-31","2024-12-30","2024-05-02","2024-10-23","2023-11-02","2024-07-18","2024-10-08","2024-08-29","2024-10-31","2024-10-31","2024-10-31","2024-10-31","2024-05-13","2024-10-08","2023-01-09","2023-09-29","2023-01-09","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-09-13","2022-09-20"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ONETOUCH DELICA","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","FLUCELVAX QUAD 2022-2023","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","PFIZER 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":""}]}]}