{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janet T Silva","gend":1,"currentgend":"","add":"10 BRADBURY ST","city":"BELFAST","state":"ME","zip":"04915","dob":"1958-02-14","age":"","mstatus":"","insh":"10000103367","cliId":"","pno":6035661115,"cno":"","email":"janetsilva603@gmail.com","ename":"","eno":"","pphy":"BROWN, JASON","ppno":2076218800,"pcpadd":"Augusta Family Medicine,15 Enterprise Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"AUGUSTA FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 28","madd2":"","madd3":"","mcity":"BELFAST","mstate":"ME","mzip":"04915","pcpfaxno":2076218801,"pcpnpi":1740592658,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5PV2M50XR88","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","K219","K649","A6009","M25552","J329","J209","J069","M47817","M5450","Z08","E8352","R059","B349","R6889","R058","E210","M5442","N3001","R590","Z1231","Z136","L905","L578","I781","D2371","D485","R000","Z20822","R030","M8589","R051","N200","C9110","Z0101","C9111","R7989","Z9221","L570","R61","L821","D1801","H35362","M810","R300","J189","E785","Z79899","L858","D122","Z1211","R918","K5730","Z860100","Z841","R221","M7918","Z0100","I878","N390","J219","J984","I2510","J439","Z87442"],"date":["2025-09-23","2023-01-18","2023-01-18","2023-01-18","2025-05-14","2024-11-18","2024-11-14","2024-12-03","2025-04-17","2025-04-17","2025-01-21","2024-03-01","2024-11-18","2023-03-23","2023-11-28","2024-04-20","2025-09-10","2025-10-17","2024-09-05","2023-11-30","2025-07-08","2024-08-27","2025-03-07","2025-03-07","2025-03-07","2025-03-07","2025-03-07","2023-03-23","2023-03-23","2023-11-30","2024-04-10","2024-12-03","2024-05-10","2024-02-23","2023-05-03","2025-01-21","2025-01-21","2025-01-21","2025-03-07","2023-12-18","2025-03-07","2025-03-07","2025-04-17","2025-09-10","2024-05-17","2024-03-10","2025-09-30","2024-09-17","2024-05-09","2025-07-14","2025-07-14","2024-11-14","2025-07-14","2025-07-14","2025-09-10","2023-11-27","2025-03-07","2025-04-17","2024-05-10","2024-06-01","2024-03-10","2024-03-10","2024-03-10","2024-01-08","2025-03-05"],"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":[["","","ESTRADIOL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","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":""}]}]}