{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER M GIFFORD","gend":1,"currentgend":"","add":"120 KULLGREN RD","city":"TEMPLE","state":"NH","zip":"03084","dob":"1956-12-14","age":"","mstatus":"","insh":10000101395,"cliId":"","pno":6038014605,"cno":"","email":"declined@09242024.com","ename":"","eno":"","pphy":"KOKAL, KAYLA L","ppno":6039244664,"pcpadd":"Monadnock Family Care,458 Old Street Rd Ste 207","pcpcity":"Peterborough","pcpstate":"NH","pcpzip":"03458","pcpcounty":"","pcpid":"","pcpname":"MONADNOCK FAMILY CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 161","madd2":"","madd3":"","mcity":"TEMPLE","mstate":"NH","mzip":"03084","pcpfaxno":"","pcpnpi":1790201887,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4U54EU0HF70","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M67911","M75112","M75111","R42","F10939","R1310","M25512","M19011","M19012","R051","Z01818","N1831","I10","E876","M7918","Z79891","Z01812","S43421A","G8918","S43431A","Z008","N179","M19021","R1110","R197","E860","E8342","E8351","I4581","R112","M5416","M25511","G4700","M25521","R059","R000","K2100","Z79899","A084","K2289","N049","R3915","M542","T1490XA","R569","R0902","R7881","B952","R109","K5730","Z9049","S22080A","S32010A","S32020A","R1319","D6489","R945","F1010","I509","S22089A","F10131","R809","M419","M546","F10239","D472","S0990XA","S199XXA","S3991XA","S3992XA","Z0100","H43813","R0989","K2970","K2950","K2090","R233","L814","L821","D485","K222","K219","L820","F331","F411","F1020","R932","R6889","F339","R279","Z1231","H04123","H26493","Z8679","F418","E039","M62838","Z0000","R2681","S81802A","Z8719","K2270","K2080","I8310","D225","D2261","D2262","R002","R079","G250","R61","R1012","K8689","K5790","K760","K828","K838","R1011","K8510","K8520","Z09","K700","R29898","I951","N390","E871","T148XXA","W19XXXA","F1090","D649","R296","M19072","M47812","M79604","M7989","R34","R0789","H0102A","Z961","H0102B","K811","B379","L74519"],"date":["2024-11-05","2024-11-12","2025-02-21","2024-06-12","2024-10-22","2024-10-15","2025-01-14","2024-12-02","2024-12-02","2024-12-23","2025-02-11","2025-01-14","2025-01-14","2025-01-31","2025-01-23","2025-01-23","2025-02-11","2025-02-21","2025-02-21","2025-02-21","2025-02-11","2024-08-14","2023-09-29","2023-10-20","2023-10-20","2024-07-08","2023-08-21","2023-08-21","2023-08-18","2023-08-18","2023-09-28","2023-09-28","2023-12-12","2023-09-29","2024-02-26","2023-11-16","2023-10-26","2023-10-26","2023-10-26","2023-11-08","2023-11-09","2023-11-06","2023-11-16","2023-11-16","2023-11-21","2023-11-16","2023-11-20","2023-11-19","2023-11-16","2023-11-16","2023-11-16","2023-12-18","2023-11-17","2023-11-17","2024-04-29","2023-11-20","2023-11-20","2023-11-20","2023-11-20","2023-11-30","2023-11-16","2023-12-07","2023-12-12","2023-12-12","2023-12-30","2023-12-27","2023-11-16","2023-11-16","2023-11-16","2023-11-16","2024-02-01","2024-02-01","2024-02-02","2024-05-02","2024-05-02","2024-05-02","2024-05-23","2024-05-23","2024-05-23","2024-05-23","2024-05-28","2024-05-02","2024-05-23","2024-08-15","2024-07-31","2024-07-31","2024-08-14","2024-08-14","2024-08-13","2024-08-15","2024-09-18","2023-01-30","2023-01-30","2022-11-01","2022-11-01","2022-12-29","2022-12-02","2022-12-29","2023-01-24","2023-03-21","2023-03-27","2023-03-27","2023-03-27","2023-04-20","2023-04-20","2023-04-20","2023-04-20","2023-04-25","2023-04-25","2023-04-25","2023-04-25","2023-06-13","2023-06-13","2023-06-13","2023-06-15","2023-06-15","2023-06-15","2023-06-15","2023-06-17","2023-06-13","2023-06-21","2023-06-16","2023-06-22","2023-06-23","2023-06-23","2023-06-23","2023-06-23","2023-06-23","2023-06-22","2023-07-05","2023-06-22","2023-06-22","2023-06-22","2023-06-22","2023-06-22","2023-08-18","2023-08-17","2023-05-09","2023-05-09","2023-05-09","2023-06-17","2023-08-30","2023-09-19"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CLONIDINE","","","Select","Select",""],["","","GLYCOPYRROLATE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","CALCITONIN-SALMON","","","Select","Select",""],["","","PROAIR RESPICLICK","","","Select","Select",""],["","","THALITONE","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","KLOR-CON M20","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MUPIROCIN","","","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":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}