{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah L Sitterly","gend":1,"currentgend":"","add":"58 BRANCHVIEW DR","city":"ELLSWORTH","state":"ME","zip":"04605","dob":"1956-06-09","age":"","mstatus":"","insh":"10000108582","cliId":"","pno":2076644657,"cno":"","email":"jdsitterly@gmail.com","ename":"","eno":"","pphy":"MARLOWE FLANAGAN, LAURA","ppno":2076675899,"pcpadd":"Trenton Health Center,394 Bar Harbor Rd","pcpcity":"Trenton","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"TRENTON HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"58 BRANCHVIEW DR","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2076647721,"pcpnpi":1790037620,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9KC4D79HQ72","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5136","M059","Z79899","J370","R519","K2270","H608X3","K319","R6889","Z1211","Z1231","Z86010","Z8371","K5730","K3580","K388","N6489","M069","K35891","R002","Z780","M810","I2510","Z48815","K259","I4710","Z0000","R011","Z955","K3533","I4510","Z0100","H35373","Z13820"],"date":["2024-05-01","2025-07-17","2025-07-17","2025-02-11","2024-02-09","2024-01-04","2024-02-09","2023-08-10","2023-10-10","2023-08-10","2025-03-10","2023-08-10","2023-08-10","2025-04-29","2025-04-29","2025-04-29","2025-03-10","2023-09-06","2025-04-29","2024-07-12","2025-03-19","2025-03-19","2025-08-06","2025-05-15","2024-01-04","2025-08-06","2025-06-18","2024-06-27","2025-08-06","2025-04-29","2025-08-06","2023-12-14","2023-12-14","2025-03-19"],"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":[["","","PREVIDENT","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","HUMIRA(CF) PEN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","IDACIO(CF) PEN (2 PACK)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","SODIUM FLUORIDE 5000 PLUS","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SODIUM FLUORIDE","","","Select","Select",""],["","","ADALIMUMAB-AACF(CF) PEN (2 PK)","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","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":""}]}]}