{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ann B Crocker","gend":1,"currentgend":"","add":"674 HALLOWELL LITCHFIELD DR","city":"West Gardiner","state":"ME","zip":"04345","dob":"1947-07-01","age":"","mstatus":"","insh":"00007480500","cliId":"","pno":"2077243784","cno":"2077516832","email":"abcrocker@roadrunner.com","ename":"","eno":"","pphy":"STRICKLAND, DONALD J","ppno":"2076238434","pcpadd":"\tKennebec Internal Medicine,9 Glenridge Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"KENNEBEC INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"674 HALLOWELL LITCHFIELD RD","madd2":"","madd3":"","mcity":"West Gardiner","mstate":"ME","mzip":"04345","pcpfaxno":"2076214370","pcpnpi":"1861431819","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4JV2DU3FR88","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R21","G1229","G14","G250","I679","R6889","Z0100","M85859","B351","M8589","M25551","M1611","M810","E042","L821","L728","L718","D2262","Z1231","M48061","M5126","M47817","M4316","E559","R5383","E785","Z0000","R079","R0602","M549","R270","M1612","M25552","M2170","Z471","D492","Z96642","G8929","K5900","R262","Z736","M25562","Z4789","Z79899","M21752","R059","R432","U071","Z13820","I493","K219","R4182","M160","M25559","Z780","M7918","Z01818","L249","D225","Z85820","L820","R002","R9089","I6782","M4802","M4722","M4312"],"date":["2023-06-27","2025-03-04","2025-03-04","2025-03-04","2023-07-24","2023-08-29","2025-05-19","2023-09-11","2023-09-14","2025-10-29","2023-09-28","2023-09-28","2025-07-22","2025-09-22","2024-10-09","2023-10-24","2023-10-24","2023-10-24","2023-11-14","2023-12-08","2023-12-08","2023-12-08","2023-12-08","2024-03-13","2025-11-13","2025-11-13","2025-11-13","2024-03-12","2024-03-12","2024-03-12","2024-04-19","2024-11-12","2026-02-26","2024-07-18","2025-02-04","2025-11-11","2026-02-26","2024-11-27","2024-11-25","2024-12-02","2024-12-02","2026-02-16","2024-11-27","2024-11-27","2024-10-01","2024-09-16","2024-09-16","2024-09-16","2025-10-29","2024-10-18","2024-11-11","2024-11-11","2024-07-18","2026-02-17","2025-10-29","2026-02-26","2024-10-01","2024-10-09","2024-10-09","2024-10-09","2025-11-11","2024-10-17","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31"],"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":[["","","Metronidazole 0.75 % Cream Prasco","","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","METRONIDAZOLE","0.0075","","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":""}]}]}