{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martha A Barksdale","gend":1,"currentgend":"","add":"31 ROCKLEDGE RD","city":"SOUTH THOMASTON","state":"ME","zip":"04858","dob":"1940-11-14","age":"","mstatus":"","insh":"10000010234","cliId":"","pno":"2074669021","cno":"2074669021","email":"mbplus3.zero48@icloud.com","ename":"","eno":"","pphy":"WILEY, JENNIFER S","ppno":"2073015800","pcpadd":"Pen Bay Internal Medicine,4 Glen Cove Dr Ste 202","pcpcity":"Rockport","pcpstate":"ME","pcpzip":"04856","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"31 ROCKLEDGE RD","madd2":"","madd3":"","mcity":"SOUTH THOMASTON","mstate":"ME","mzip":"04858","pcpfaxno":"2073015332","pcpnpi":"1306846423","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1JA2T97QJ06","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B350","C50811","I700","G620","M2141","M2142","N8189","Z4689","M542","N1830","Z853","Z85828","Z131","C50911","N2581","N1832","Z0000","C50912","I7143","D485","Z85820","L218","L821","D2271","M1612","M65332","H25813","R351","H6123","Z13820","M8589","R310","Z961","E785","I499","R4182","H2512","R059","R509","H25811","J329","Z87891","R39198","C50812","M25572","H3554","M79672","Z452","M7989","M19072","M79605","I82442","I824Y2","I82492","H353221","I824Z2"],"date":["2023-04-25","2024-03-18","2023-04-25","2023-04-25","2023-08-09","2023-08-09","2024-06-11","2024-03-18","2023-07-03","2023-07-03","2023-07-03","2023-08-01","2023-07-13","2024-03-29","2023-07-27","2023-07-27","2024-03-12","2023-07-12","2023-07-12","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2024-05-17","2023-08-24","2024-02-01","2023-10-31","2023-11-14","2023-11-29","2023-11-29","2023-12-19","2024-03-05","2024-02-01","2024-01-11","2024-02-01","2024-01-11","2024-02-04","2024-02-04","2024-02-01","2024-02-04","2024-06-26","2024-02-09","2024-03-18","2024-03-26","2024-05-22","2024-06-26","2024-06-21","2024-06-26","2024-06-26","2024-06-27","2024-06-27","2024-06-27","2024-06-26","2024-07-02","2024-07-05"],"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":[["","","Calcitriol","0.5 MCG","","Select","Select",""],["","","Amoxicillin\/Clav","500\/125 MG","","Select","Select",""],["","","Prolensa","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Tamoxifen","20 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Terconazole","80 MG","","Select","Select",""],["","","Pravastatin","40 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","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":""}]}]}