{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vickie D Hartford","gend":1,"currentgend":"","add":"166 PLAINS RD","city":"LEEDS","state":"ME","zip":"04263","dob":"1958-06-18","age":"","mstatus":"","insh":"10000111546","cliId":"","pno":2072120093,"cno":"","email":"franciecat22@yahoo.com","ename":"","eno":"","pphy":"ASSADOLLAHZADEH, MINA","ppno":2077774440,"pcpadd":"St Marys Center for Family Medicine,15 Mollison Way","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"ST MARYS CENTER FOR FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"166 PLAINS RD","madd2":"","madd3":"","mcity":"LEEDS","mstate":"ME","mzip":"04263","pcpfaxno":2077778197,"pcpnpi":1487068698,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5JR3WG4JY91","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1711","I480","I4710","E782","I10","G4733","R300","N390","M65331","M65341","I83812","M79671","Z1231","E119","Z7901","S93601A","M722","M25474","D649","M76821","Z961","R102","N369","L814","D225","L821","L218","Z6842","H906","H9313","J300","K5730","E279","N289","H903","R3914","Z0000","I872","Z1211","Z1212","Z0101","R7303","I8392","D485","R42","R0789","Z20822","I83811","M19031","M1811","J301","I83892","K219","F418","D509","E6601","Z6841","R350","Z48812","M2550","L570","M19071","M25561"],"date":["2025-09-22","2025-09-30","2024-10-14","2025-09-30","2025-09-30","2025-10-21","2025-10-20","2025-10-20","2025-09-15","2025-09-15","2025-03-13","2025-07-17","2025-05-13","2024-03-25","2024-03-25","2025-07-17","2025-07-17","2025-07-17","2025-09-23","2024-01-30","2024-04-15","2024-05-28","2024-05-28","2025-04-22","2025-04-22","2025-04-22","2024-04-05","2024-03-11","2024-06-25","2024-08-01","2024-06-25","2024-05-28","2024-05-28","2024-05-28","2024-08-01","2024-07-08","2024-12-09","2025-02-24","2025-06-04","2025-06-04","2024-10-16","2024-10-16","2025-04-22","2025-04-22","2025-10-03","2025-10-03","2025-10-03","2025-02-24","2025-09-15","2025-09-15","2025-07-23","2025-03-13","2024-03-25","2024-03-25","2025-08-21","2024-03-11","2024-03-11","2024-08-22","2025-02-24","2025-05-09","2025-04-22","2024-01-30","2024-12-02"],"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","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","KLOR-CON M20","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","TAMSULOSIN 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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"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":""}]}]}