{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Holly A Mccormick","gend":1,"currentgend":"","add":"555 GARLAND RD","city":"DEXTER","state":"ME","zip":"04930","dob":"1965-06-29","age":"","mstatus":"","insh":"10000110327","cliId":"","pno":2074181476,"cno":"","email":"dynahd532@gmail.com","ename":"","eno":"","pphy":"MACDONALD, MICHAEL C","ppno":2073736848,"pcpadd":"22 STATION AVE,SUITE 101","pcpcity":"BRUNSWICK","pcpstate":"ME","pcpzip":"40112092","pcpcounty":"","pcpid":"","pcpname":"SEBASTICOOK FAMILY DOCTORS","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"555 GARLAND RD","madd2":"","madd3":"","mcity":"DEXTER","mstate":"ME","mzip":"04930","pcpfaxno":2073736849,"pcpnpi":1235220740,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XP8X11EF44","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","R739","E049","H04123","G43409","R7301","E039","E041","F411","G43411","F419","Z23","R531","A6000","F349","R002","N760","D123","D125","Z1211","I493","G43709","Z0000","L219","M62838","S79911A","R5383","Z1231","N644","S6992XA","S63502A","F4001","G43909","R000","I491","K641","S93402A","F410","F341","H353131","H2513","H25013","Z86010","K5730"],"date":["2025-10-20","2024-10-09","2025-06-17","2025-05-06","2025-08-21","2025-10-20","2025-10-20","2025-06-17","2025-10-27","2025-04-15","2024-02-07","2025-11-12","2025-10-15","2024-10-05","2024-09-05","2024-02-23","2025-06-23","2024-01-30","2024-01-30","2024-01-30","2024-01-10","2024-09-05","2025-10-20","2025-10-20","2024-01-10","2024-01-12","2024-03-27","2025-08-15","2025-10-06","2024-01-12","2024-01-12","2025-01-07","2024-10-09","2024-03-18","2024-03-18","2024-01-30","2024-01-11","2024-04-17","2024-04-17","2025-05-06","2025-05-06","2025-05-06","2024-01-30","2024-01-30"],"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":[["","","NURTEC ODT","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","MINOCYCLINE HCL","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CROMOLYN SODIUM","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","NP THYROID","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","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":""}]}]}