{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah S Kelley","gend":1,"currentgend":"","add":"647 WEST ST","city":"PRINCETON","state":"ME","zip":"04668","dob":"1956-08-24","age":"","mstatus":"","insh":"10000102387","cliId":"","pno":2072148522,"cno":"","email":"declined@02242023.com","ename":"","eno":"","pphy":"SMALL, JANICE M","ppno":2077965503,"pcpadd":"St Croix Regional Family He,136 Mill St","pcpcity":"Princeton","pcpstate":"ME","pcpzip":"04668","pcpcounty":"","pcpid":"","pcpname":"ST CROIX REGIONAL FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"647 WEST ST","madd2":"","madd3":"","mcity":"PRINCETON","mstate":"ME","mzip":"04668","pcpfaxno":2077965528,"pcpnpi":1457724148,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2MA5UT2UE52","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4700","R1310","S93401A","J449","Z1231","N898","G5603","F4310","S8264XA","S93402A","S63501A","W010XXA","K319","K219","Z87891","R519","H04123","H02412","H47323","G4489","G43909","R202","D801","H608X3","F458","J370","Z23","N952","I083","I868","F331","R6889","M25511","G319","M810","M8589","E785","I351","R002","Z98890","F419","M316","E039","E349","M542","I7789","J029","M79641","Z01812","H02402","M4802","M5030","E0590","G500","Z01818","R1314","R1084","G8929","M50322","R195","R5383","Z13220","A0472","Z9049","Q180","R197","W57XXXA","S82831D","K225","Z0000","M353","Z79899","R200","Z961","H02881","H02884","D649","Z881","R4189","J329","Q396","K224","K599","R918","K3189","K5900","M1990","M25572","S99912A","M25571","S99911A","M25531","S6991XA"],"date":["2025-01-13","2025-07-10","2025-05-21","2025-05-01","2025-04-28","2024-10-22","2025-05-14","2024-11-13","2025-05-16","2025-05-16","2025-05-16","2025-05-16","2025-04-03","2024-06-17","2023-05-10","2024-09-03","2023-10-30","2023-10-30","2024-05-14","2025-06-10","2025-06-10","2025-06-10","2025-05-30","2023-12-14","2023-04-05","2023-12-14","2023-11-29","2024-12-04","2025-06-11","2025-06-11","2024-11-26","2023-12-12","2024-08-29","2023-09-18","2024-04-17","2024-04-09","2024-01-29","2025-06-11","2023-06-01","2024-08-30","2024-08-29","2024-08-29","2024-04-17","2024-04-17","2024-04-22","2023-11-15","2024-04-05","2024-04-30","2024-08-30","2024-03-12","2025-08-21","2024-02-12","2025-01-30","2024-01-02","2024-02-01","2024-02-26","2024-12-17","2025-05-22","2024-02-12","2025-01-24","2025-01-30","2025-01-30","2023-06-22","2023-06-22","2023-06-22","2025-07-10","2024-10-03","2025-05-21","2024-02-01","2024-10-29","2024-06-28","2024-06-28","2025-04-18","2023-03-16","2023-03-16","2023-03-16","2024-12-17","2024-12-17","2024-06-19","2025-04-18","2024-06-17","2024-06-17","2024-06-17","2023-06-01","2025-04-03","2025-07-10","2022-12-06","2025-05-16","2025-05-16","2025-05-16","2025-05-16","2025-05-16","2025-05-16"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ZOLPIDEM TARTRATE ER","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CARBAMAZEPINE","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","BACITRACIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","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":""}]}]}