{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Geraldine M Spencer","gend":1,"currentgend":"","add":"19 JEFFERSON ST","city":"BREWER","state":"ME","zip":"04412","dob":"1955-03-14","age":"","mstatus":"","insh":"10000098025","cliId":"","pno":2079896841,"cno":"","email":"decline2024@nothanks.com","ename":"","eno":"","pphy":"ROXAS, RODRIGO C","ppno":2079073777,"pcpadd":"EMMC Family Medicine of Brewer,234 State St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"19 JEFFERSON ST","madd2":"","madd3":"","mcity":"BREWER","mstate":"ME","mzip":"04412","pcpfaxno":2077778800,"pcpnpi":1023204641,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8AK1K58DM16","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K743","R7989","C50011","G4733","C50111","Z0000","D229","L814","C50911","Z800","Z803","R29898","L309","R6889","H40003","E559","I471","I77810","Z170","E782","L570","C50919","C50811","Z5111","L821","I340","M810","Z1231","J309","Z1721","Z1732","K5900","Z79811","Z87891","Z510","M8589","Z0101","H52223","Z124","Z01411","R7303","N819","R058","K754","H43813","Z23","R92323","R921","Z853","N6453","Z923","I081","Z9989","H40023","Z5181","Z1211","K5140","Z86010","K5730","K648","K635"],"date":["2024-12-11","2025-11-12","2025-08-11","2025-11-13","2025-01-24","2025-05-06","2025-04-15","2025-04-15","2025-06-02","2024-05-23","2024-05-23","2024-05-08","2024-07-27","2023-01-09","2024-11-19","2023-06-13","2023-06-13","2025-09-24","2025-02-17","2022-12-09","2025-04-15","2025-08-11","2025-02-17","2024-08-06","2024-07-29","2025-09-24","2024-10-22","2023-06-13","2024-05-08","2025-02-17","2025-02-17","2024-12-11","2024-11-06","2024-06-24","2024-10-01","2024-10-22","2025-11-12","2025-11-12","2022-11-28","2024-03-20","2024-11-09","2024-12-10","2023-04-10","2024-05-17","2025-11-12","2024-11-12","2025-05-08","2024-05-06","2025-05-08","2024-03-20","2024-11-06","2022-11-03","2022-11-11","2022-10-12","2022-10-19","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-09-19"],"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":[["","","URSODIOL","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)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":""}]}]}