{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deanna M Rogers","gend":1,"currentgend":"","add":"25 BONNIE WAY","city":"CASCO","state":"ME","zip":"04015","dob":"1957-08-01","age":"","mstatus":"","insh":"10000097602","cliId":"","pno":2076327135,"cno":"","email":"","ename":"","eno":"","pphy":"CATHCART, WENDY","ppno":2077745816,"pcpadd":"Intermed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 BONNIE WAY","madd2":"","madd3":"","mcity":"CASCO","mstate":"ME","mzip":"04015","pcpfaxno":2078741483,"pcpnpi":1295704971,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6Y63TY0DM84","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25519","H16223","M75121","E669","I10","G4730","H43813","R0683","G4719","J310","M25461","M19012","M19011","M25512","S46011D","M25511","M25411","Z23","M62511","E785","R7303","M65342","M65811","M24111","Z1231","R519","D23121","H02831","H02834","H02832","Z0001","G8918","Z4789","M25542","S46011A","M1711","M25561","Z124","Z1151","R6889","M25562","Z01419","M8588","M1712"],"date":["2023-05-31","2024-01-11","2023-09-19","2023-09-19","2024-05-28","2023-09-19","2024-01-11","2023-08-08","2023-04-25","2023-04-25","2023-06-28","2024-07-09","2023-09-27","2023-12-11","2024-01-09","2023-12-11","2023-12-11","2024-01-02","2023-12-04","2024-04-24","2024-04-24","2024-03-14","2023-06-13","2023-06-13","2024-06-19","2023-02-14","2023-01-30","2023-01-30","2023-01-30","2023-01-30","2024-05-15","2023-09-19","2023-09-27","2024-03-14","2023-09-19","2023-07-18","2023-06-04","2022-08-19","2022-08-19","2022-08-18","2022-08-23","2022-08-19","2022-08-19","2022-07-06"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","NAPROXEN","","","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":""}]}]}