{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tanya Pasquarelli","gend":1,"currentgend":"","add":"175 BENN HILL RD","city":"Houlton","state":"ME","zip":"04730","dob":"1959-02-03","age":"","mstatus":"","insh":"10000119883","cliId":"","pno":2075211666,"cno":"","email":"tanyapasqua23@gmail.com","ename":"","eno":"","pphy":"OLABIYI, SOLOMON B","ppno":2075322234,"pcpadd":"Sigrid E Tompkins Health Center,22 Hartford St","pcpcity":"Houlton","pcpstate":"ME","pcpzip":"04730","pcpcounty":"","pcpid":"","pcpname":"SIGRID E TOMPKINS HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1004","madd2":"","madd3":"","mcity":"Houlton","mstate":"ME","mzip":"04730","pcpfaxno":2075329426,"pcpnpi":1366734170,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1D13DX2AH06","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C20","C3411","C342","Z933","K631","B354","Z510","K760","K602","C19","C7801","Z08","K6289","Z48813","R918","Z01818","R911","K6389","Z85038","J9811","Z85048","Z923","Z87891","R7309","Z1211"],"date":["2025-07-24","2025-01-20","2025-01-20","2025-07-24","2025-07-24","2025-07-24","2025-03-05","2025-03-24","2025-08-27","2025-04-16","2025-02-19","2025-08-26","2025-07-11","2025-01-20","2025-06-10","2025-01-02","2025-06-10","2025-07-11","2025-07-11","2025-01-06","2025-08-27","2025-08-27","2025-08-27","2025-04-02","2025-09-11"],"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":[["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","MORPHINE SULFATE ER","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","ONDANSETRON 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":[]}},{"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":""}]}]}