{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nadine M Goodwin","gend":1,"currentgend":"","add":"52 DODGE POINT RD","city":"SEAL COVE","state":"ME","zip":"04674","dob":"1957-06-18","age":"","mstatus":"","insh":"10000096692","cliId":"","pno":2072447515,"cno":"","email":"","ename":"","eno":"","pphy":"HANKE, TANYA","ppno":2072445630,"pcpadd":"10 WAYMAN LN,","pcpcity":"BAR HARBOR","pcpstate":"ME","pcpzip":"46091625","pcpcounty":"","pcpid":"","pcpname":"MDI COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"52 DODGE POINT RD","madd2":"","madd3":"","mcity":"SEAL COVE","mstate":"ME","mzip":"04674","pcpfaxno":"","pcpnpi":1760644082,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4AE0UV9MV90","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H2512","Z96659","Z1231","H40013","R519","H43393","H25093","L600","H4911","H532","H353130","Z961","H353131","H35383","H35723","U071","Z4889","R197","M2012","H2511","Z1211","H353132","Z98890","H2513","Z5189","M3500","H353221","H353111","H35363","M79672","M5450","M2042","E739","Z0000","D122","D123","M25562","M9903","M545","M9901","M9902","R058","J45909","Z48810","R42","H539","H401131","Z79899","J209","J205","H04123","R0602","M810","H538","H26493","J3089","R059","E6609","I7300","M62830","M546","M2041"],"date":["2023-10-17","2023-08-03","2024-09-26","2024-12-05","2022-11-03","2025-06-12","2023-03-29","2022-12-14","2024-07-09","2024-07-09","2024-07-09","2024-07-09","2025-06-12","2025-07-18","2025-07-18","2022-11-25","2023-08-01","2022-10-26","2023-06-26","2023-10-12","2023-02-22","2023-09-11","2024-08-20","2023-08-09","2025-01-26","2025-05-13","2025-09-11","2025-09-11","2023-01-09","2023-06-21","2023-05-10","2023-06-21","2023-06-21","2024-08-29","2023-02-22","2023-02-22","2024-10-30","2023-11-21","2023-11-21","2023-11-21","2023-11-21","2025-04-24","2024-05-23","2024-07-10","2022-10-06","2022-10-10","2025-06-12","2025-06-12","2024-01-27","2024-02-12","2023-03-29","2025-01-28","2024-08-13","2023-11-14","2024-12-05","2025-05-27","2024-01-27","2024-10-17","2024-11-18","2024-08-09","2023-10-03","2022-08-17"],"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":[["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","NIFEDIPINE ER","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","FLOVENT HFA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","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":""}]}]}