{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jon P Cram","gend":0,"currentgend":"","add":"117 DIXON RD","city":"Lebanon","state":"ME","zip":"04027","dob":"1938-05-31","age":"","mstatus":"","insh":"00008367700","cliId":"","pno":"2076587720","cno":"","email":"cramjon24@gmail.com","ename":"","eno":"","pphy":"SMITH, JOAN D","ppno":"6036642135","pcpadd":"789 CENTRAL AVE,","pcpcity":"DOVER","pcpstate":"NH","pcpzip":"38202526","pcpcounty":"","pcpid":"","pcpname":"WHP BARRINGTON HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"117 DIXON RD","madd2":"","madd3":"","mcity":"Lebanon","mstate":"ME","mzip":"04027","pcpfaxno":"6036649128","pcpnpi":"1689613242","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8QA0GE4MQ31","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","H5213","H52223","H524","H25813","H3554","I4892","E785","I440","R9431","R918","M19041","M19042","J849","I2720","J189","R051","R0600","R0602","E039","J9601","M7989","M1990","I4891","J8410","R791","R059","R39198","I10"],"date":["2024-08-12","2024-08-12","2024-08-12","2024-08-12","2024-08-12","2024-08-12","2025-07-28","2025-10-16","2025-07-28","2024-03-20","2025-09-18","2025-09-15","2025-09-15","2025-12-29","2026-01-14","2025-07-07","2025-06-23","2025-08-11","2025-07-25","2025-10-16","2025-07-28","2025-08-25","2025-10-16","2025-07-28","2025-07-25","2025-07-25","2025-07-25","2023-02-22","2023-02-22"],"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":[["","","ATORVASTATIN","20 MG","","Select","Select",""],["","","LEVOTHYROXINE","50 MCG","","Select","Select",""],["","","ROSUVASTATIN","40 MG","","Select","Select",""],["","","CAPVAXIVE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","Tobramycin\/Dex 0.3\/0.1 % Ophth Susp Sandoz","","","Select","Select",""],["","","SOTALOL","80 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","PREDNISONE","5 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","NAPROXEN","500 MG","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","CEFUROXIME","500 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","TOBRAMYCIN\/DEX","0.3\/0.1 %","","Select","Select",""],["","","SPIKEVAX","","","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":""}]}]}