{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Margaret S Morris","gend":1,"currentgend":"","add":"133 BROADVIEW AVE","city":"AUBURN","state":"ME","zip":"04210","dob":"1955-07-26","age":"","mstatus":"","insh":"10000100037","cliId":"","pno":6319911678,"cno":6319911678,"email":"pjnmorris@yahoo.com","ename":"","eno":"","pphy":"HILARY, MANJU","ppno":2076573308,"pcpadd":"126 SHAKER RD,","pcpcity":"GRAY","pcpstate":"ME","pcpzip":"40399629","pcpcounty":"","pcpid":"","pcpname":"GRAY FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"133 BROADVIEW AVE","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":2076573309,"pcpnpi":1710066410,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1YT4UK9HU68","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","Z1231","L814","L821","D225","Z08","Z0000","E782","I10","R1013","K580","H43813","H25813","H353131","F321","E6601","Z6843","M5450","H8102","I890","Z0101","H2513","L820","R208","Z789","L538","G8929","F330","F4321","Z79899","E876","F32A","G4700","Z8739","H903","E559","J069","H9192","M85852"],"date":["2025-10-08","2024-12-17","2025-10-20","2025-10-20","2025-10-20","2025-10-20","2024-11-26","2025-07-02","2025-05-15","2025-11-04","2025-11-04","2025-07-22","2025-07-22","2025-07-22","2024-08-28","2024-01-18","2024-01-18","2024-06-13","2024-06-11","2024-09-09","2024-07-15","2024-07-15","2023-10-13","2023-10-13","2023-10-13","2023-10-13","2024-04-16","2024-03-15","2024-03-15","2024-03-15","2023-06-29","2023-06-29","2023-06-29","2023-06-29","2022-11-29","2024-03-15","2024-10-17","2022-11-14","2022-11-16"],"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":[["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PREVNAR 20","","","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":{"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":""}]}]}