{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sally J Cocco","gend":1,"currentgend":"","add":"620 HALEY RD","city":"KITTERY POINT","state":"ME","zip":"03905","dob":"1958-09-21","age":"","mstatus":"","insh":"10000108437","cliId":"","pno":6039571762,"cno":"","email":"sallyjcocco@gmail.com","ename":"","eno":"","pphy":"JEAN, NATHAN","ppno":2074394430,"pcpadd":"Kittery Family Practice,35 Walker St","pcpcity":"Kittery","pcpstate":"ME","pcpzip":"03904","pcpcounty":"","pcpid":"","pcpname":"KITTERY FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"620 HALEY RD","madd2":"","madd3":"","mcity":"KITTERY POINT","mstate":"ME","mzip":"03905","pcpfaxno":2074390968,"pcpnpi":1215164082,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3HH6WU4DN55","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42","R2689","M65351","M79644","M79645","Z0101","H40012","H9042","F331","Z23","F329","F4381","R55","R293","S40262A","Z01810","I10","M85852","Z780","L821","L814","D2339","D2372","M19042","H43813","Z9884","L570","L299","E039","Z0000","M19041","N959","H01009","H2513","F419","R197","R930","F332","M159","E079","Z48815","Z91018","M180","Z1231","F4321","Z1211","R6889","H5203","H52223","E66811","E6609","Z6832"],"date":["2025-06-10","2025-01-22","2025-05-30","2025-05-30","2025-05-30","2023-10-13","2024-10-15","2025-02-05","2025-04-03","2024-10-25","2025-09-09","2025-09-23","2024-02-20","2024-10-16","2024-03-11","2025-07-11","2025-07-11","2024-10-10","2024-10-10","2023-10-23","2023-10-23","2023-10-23","2023-10-23","2025-04-22","2024-10-23","2024-12-04","2024-11-27","2024-08-30","2025-06-17","2025-03-04","2025-04-22","2024-10-10","2024-02-14","2024-02-14","2024-02-16","2024-12-21","2025-07-22","2024-07-26","2024-07-26","2024-12-04","2024-12-04","2025-06-03","2025-05-05","2024-06-28","2025-03-17","2025-06-17","2023-12-19","2024-10-15","2024-10-15","2024-12-16","2024-12-16","2024-12-16"],"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":[["","","SYNTHROID","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ARIPIPRAZOLE","","","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":""}]}]}