{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karen L Hawksley","gend":1,"currentgend":"","add":"ALLEN ST 14 RICE WAY","city":"RANGELEY","state":"ME","zip":"04970","dob":"1953-04-11","age":"","mstatus":"","insh":"10000104016","cliId":"","pno":2078643610,"cno":2076708246,"email":"Kennelqueen60@gmail.com","ename":"","eno":"","pphy":"SINCEBAUGH, ELS","ppno":2078643303,"pcpadd":"Rangeley Family Medicine,42 Dallas Hill Rd","pcpcity":"Rangeley","pcpstate":"ME","pcpzip":"04970","pcpcounty":"","pcpid":"","pcpname":"RANGELEY FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 128","madd2":"","madd3":"","mcity":"RANGELEY","mstate":"ME","mzip":"04970","pcpfaxno":2078642969,"pcpnpi":1629124136,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4V48A91WC44","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","L308","R399","R350","N390","C50912","M8580","Z170","Z85828","Z510","C50212","R92332","K2100","Z86010","R1013","Z1231","Z98890","I493","L821","L814","D485","H40023","H2513","E782","Z0101","H5203","F4323","N6320","K921","K580","R1310","R590","H9311","M4802","M50321","I890","Z01818","R1031","D360","C50412","Z0189","M26621","J449","Z87891","M8589","R928","I10","S61213A","Z1211","K635","K5730","D122","Z23","Z0389","E785","N6322","R319"],"date":["2023-10-18","2023-01-18","2024-06-27","2025-04-24","2023-11-01","2025-01-28","2024-05-22","2024-09-19","2025-01-24","2024-05-20","2025-08-13","2024-02-12","2025-05-06","2023-10-13","2023-10-13","2025-01-24","2024-04-10","2024-06-08","2025-09-16","2025-09-16","2025-09-16","2025-05-14","2024-11-14","2023-10-18","2025-05-14","2025-05-14","2025-02-03","2024-03-07","2025-05-06","2025-05-06","2025-05-06","2023-04-07","2023-04-07","2023-04-07","2023-04-07","2024-05-01","2024-02-29","2024-04-01","2024-02-19","2024-02-19","2023-04-07","2024-07-29","2023-04-07","2023-04-07","2024-05-01","2024-02-09","2023-11-09","2024-07-15","2024-02-21","2024-02-21","2024-02-21","2024-02-21","2023-10-18","2024-04-01","2025-04-28","2024-02-02","2023-10-19"],"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":[["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","TAMOXIFEN CITRATE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","LETROZOLE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","OXYCODONE HCL","","","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":[]}},{"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":""}]}]}