{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marsha J Gonya","gend":1,"currentgend":"","add":"36 WORKMAN TER","city":"LINCOLN","state":"ME","zip":"04457","dob":"1957-10-22","age":"","mstatus":"","insh":"10000098250","cliId":"","pno":2077459840,"cno":2077946025,"email":"","ename":"","eno":"","pphy":"PERFECT, JODIE","ppno":2077946700,"pcpadd":"175 W BROADWAY,PO BOX 99","pcpcity":"LINCOLN","pcpstate":"ME","pcpzip":"44574000","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 369","madd2":"","madd3":"","mcity":"KINGFIELD","mstate":"ME","mzip":"04947","pcpfaxno":2077946777,"pcpnpi":1417399205,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7X82VW9VY26","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N390","F1010","R1030","B351","R1112","Z022","Z1231","R300","F32A","F01B3","F01B11","Z0000","Z124","Z79890","N952","F419","G4700","K921","F03911","R4182","S0990XA","S199XXA","S3991XA","S3993XA","S299XXA","K5900","E876","G479","E559","K5289","E871","F418","I10","K639","F02B0","Z743","W108XXA","Z23","J029","F10229","R109","F03918","M8589","F0390","F330"],"date":["2025-03-16","2024-02-08","2025-02-09","2025-03-25","2022-11-05","2023-09-15","2024-05-03","2025-03-20","2025-07-10","2025-09-04","2025-09-04","2024-12-12","2022-12-06","2022-12-06","2022-12-06","2022-12-06","2025-07-17","2023-11-24","2025-08-07","2023-12-28","2023-12-28","2023-12-28","2023-12-28","2023-12-28","2023-12-28","2024-10-22","2025-06-18","2023-03-31","2024-03-12","2022-11-05","2023-02-22","2025-04-07","2025-04-07","2025-04-07","2025-04-07","2023-12-28","2023-12-28","2024-10-11","2024-06-14","2023-12-28","2025-04-09","2025-06-12","2024-05-03","2024-12-11","2025-09-04"],"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":[["","","MEMANTINE HCL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","SILVER SULFADIAZINE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","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":""}]}]}