{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Phyllis M Hamilton","gend":1,"currentgend":"","add":"2 RIVER RD","city":"CAPE NEDDICK","state":"ME","zip":"03902","dob":"1959-07-22","age":"","mstatus":"","insh":"10000094153","cliId":"","pno":6037678131,"cno":"","email":"","ename":"","eno":"","pphy":"CHUA, JOHANNA L","ppno":6039292137,"pcpadd":"Hampton Internal Medicine,55 High St Ste 201","pcpcity":"Hampton","pcpstate":"NH","pcpzip":"03842","pcpcounty":"","pcpid":"","pcpname":"HAMPTON INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2 RIVER RD","madd2":"","madd3":"","mcity":"CAPE NEDDICK","mstate":"ME","mzip":"03902","pcpfaxno":6039297482,"pcpnpi":1477018604,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1V88P27TU52","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0789","F419","F329","K219","M069","F331","F429","R921","D72829","E559","R079","R918","M0609","I2510","R5383","F5101","R200","R42","M2011","Z1231","F322","R0602","G238","I700","H3530","Z0000","M79672","R531","R232","Z809","J329","B9689","B3731","M79671","Z23","I10","I25110","I25118","I4510","Z7952","M8580","R4182","R5381"],"date":["2023-10-01","2024-08-07","2024-11-05","2024-08-07","2025-07-02","2025-11-17","2025-11-17","2024-06-10","2024-06-10","2024-06-10","2023-10-11","2023-09-30","2025-02-19","2025-07-22","2023-09-22","2023-10-04","2023-10-04","2023-09-28","2023-04-18","2024-06-10","2023-09-22","2023-09-22","2023-09-28","2023-09-22","2023-03-07","2024-06-03","2023-09-30","2023-09-30","2025-01-08","2025-01-08","2024-11-05","2024-11-05","2024-11-05","2023-04-18","2023-10-17","2025-07-22","2022-10-17","2022-10-11","2022-09-21","2022-09-19","2022-09-19","2022-07-15","2022-07-15"],"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":[["","","BUSPIRONE HCL","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","NAPROXEN SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","NITROGLYCERIN","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}