{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joanne C Cullins","gend":1,"currentgend":"","add":"747 STATE RD","city":"MAPLETON","state":"ME","zip":"04757","dob":"1955-05-04","age":"","mstatus":"","insh":"10000104979","cliId":"","pno":2077685980,"cno":"","email":"","ename":"","eno":"","pphy":"GROVER, ELEANOR V","ppno":2077647200,"pcpadd":"\tFull Circle Health Care,169 Academy St Ste C","pcpcity":"Presque Isle","pcpstate":"ME","pcpzip":"04769","pcpcounty":"","pcpid":"","pcpname":"FULL CIRCLE HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"747 STATE RD","madd2":"","madd3":"","mcity":"MAPLETON","mstate":"ME","mzip":"04757","pcpfaxno":2077647204,"pcpnpi":1730191172,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8PE1A72YH18","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R069","I4891","E1140","I608","J9601","I484","J441","I609","R791","G4733","R0602","Z87891","Z452","J90","J811","I10","G911","Z961","E119","D3131","I509","J9811","Z7901","I63233","D72829","R110","M47819","I618","I6032","Z48812","Z9989","I615","G910","E782","Z4682","J101","S93402A","I214","R4182","M542","R5383","F0150","E113292","H35372","I469","R1110","J189","J449","J09X2","R197","I639","F329","G4730","I480","I2510","I3481","I340","I517","I499","Z23","Z0000","K219"],"date":["2025-02-23","2025-02-25","2025-09-02","2023-12-16","2023-12-18","2023-12-16","2025-02-23","2023-12-17","2023-12-10","2025-08-26","2025-02-25","2024-08-31","2023-12-10","2023-12-10","2023-12-13","2025-09-02","2023-12-16","2025-08-05","2024-07-08","2025-08-05","2025-03-07","2023-12-09","2023-12-23","2023-12-07","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2023-12-07","2023-12-15","2023-12-07","2023-12-16","2023-12-11","2025-09-02","2023-12-07","2025-02-25","2023-12-21","2025-04-23","2023-12-07","2023-12-07","2023-12-07","2023-12-07","2025-08-05","2025-08-05","2023-12-18","2023-12-07","2023-12-10","2023-12-10","2025-02-23","2024-01-29","2023-12-19","2023-12-08","2023-12-08","2025-04-23","2025-04-23","2023-12-10","2023-12-10","2023-12-10","2023-12-10","2023-12-07","2024-05-31","2023-05-19"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","NIMODIPINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METRONIDAZOLE","","","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":{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}