{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vivian R Roderick","gend":1,"currentgend":"","add":"800 RIVER RD","city":"NORTH ANSON","state":"ME","zip":"04958","dob":"1957-10-21","age":"","mstatus":"","insh":"10000113454","cliId":"","pno":2076126976,"cno":"","email":"vivianroseroderick@icloud.com","ename":"","eno":"","pphy":"MARTOCCI, ALEXANDRA","ppno":2076724187,"pcpadd":"PO BOX 727,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49030727","pcpcounty":"","pcpid":"","pcpname":"BINGHAM AREA HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 207","madd2":"","madd3":"","mcity":"NORTH ANSON","mstate":"ME","mzip":"04958","pcpfaxno":"","pcpnpi":1245977313,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3KH5AJ4JW72","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R300","D649","M797","M25512","G5601","R1030","M1712","M5450","Z0101","H2513","H18513","H5203","S62101D","H52223","H524","Z96652","J189","S62101A","R252","Z01812","S52501D","M25561","Z1231","M25562","J069","R7989","R062","S52351A","M170","Z13820","I10","E538","E039","E6601","B179","S6291XA","M19041","Z01818","Z96651","S43401A","Z79899","Z23","G5621","S52571A","M2550","Z471","M1612"],"date":["2025-05-28","2024-05-23","2025-03-06","2025-02-05","2025-09-25","2024-08-20","2024-06-25","2025-05-28","2025-10-09","2025-10-09","2025-10-09","2025-10-09","2025-08-20","2025-10-09","2025-10-09","2024-08-01","2025-09-15","2025-06-06","2024-12-31","2024-01-25","2025-09-02","2024-01-15","2024-03-07","2024-01-17","2024-05-27","2024-09-23","2024-05-23","2025-06-10","2024-09-10","2024-02-14","2024-04-16","2024-01-11","2024-11-21","2024-06-20","2024-09-19","2025-07-15","2024-04-16","2024-01-17","2024-02-05","2025-06-05","2024-11-21","2024-09-23","2025-08-20","2025-06-05","2024-09-23","2024-06-25","2024-07-03"],"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":[["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","YUVAFEM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREVNAR 20","","","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":""}]}]}