{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Clarisse P Will","gend":1,"currentgend":"","add":"38 LONG ST","city":"Brunswick","state":"ME","zip":"04011","dob":"1931-11-07","age":"","mstatus":"","insh":"10000010646","cliId":"","pno":"2071822339","cno":"2078122329","email":"declined@01262026.com","ename":"","eno":"","pphy":"BAIER, ROBIN","ppno":"2077984400","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"38 LONG ST","madd2":"","madd3":"","mcity":"Brunswick","mstate":"ME","mzip":"04011","pcpfaxno":"2078287850","pcpnpi":"1891189288","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6M10PD1UM00","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":["M25561","G2581","M1711","M170","M11261","M11262","M353","G5601","G5602","M25461","M6530","G5622","R519","K921","K5732","D3502","K449","R935","E279","K644","R1032","K5792","R109","K5730","E278","R12","K922","K219","I10","C19","C187","Z01818","C20","R0789","E782","G8918","I2510","Z48815","Z0000","K098","M109","M1712"],"date":["2023-05-02","2023-05-04","2024-06-20","2024-05-30","2024-05-30","2024-05-30","2023-06-12","2023-05-04","2023-05-04","2023-05-02","2023-06-12","2023-06-12","2023-06-12","2023-11-21","2023-10-22","2023-10-18","2023-10-30","2023-10-18","2023-10-18","2023-10-18","2023-10-22","2023-10-22","2023-10-23","2023-11-21","2023-10-22","2023-10-30","2023-10-30","2023-11-21","2024-03-25","2023-11-21","2024-03-21","2023-12-21","2023-12-22","2024-03-25","2024-03-25","2024-01-02","2024-01-02","2024-02-09","2024-03-21","2024-03-21","2024-03-21","2024-05-30"],"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":[["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Capvaxive","","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Isosorbide Mononitrate","30 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Baclofen","10 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","Citalopram","20 MG","","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":""}]}]}