{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sharon B Benoit","gend":1,"currentgend":"","add":"9 CLUBHOUSE LN","city":"AUBURN","state":"ME","zip":"04210","dob":"1944-11-28","age":"","mstatus":"","insh":"10000010801","cliId":"","pno":"2072418852","cno":"","email":"sharonbenoit@gmail.com","ename":"","eno":"","pphy":"ELISHA, BELINDA","ppno":"","pcpadd":"99 CAMPUS AVE STE 201,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42406045","pcpcounty":"","pcpid":"","pcpname":"ST MARYS MEDICAL ASSOCIATES","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9 CLUBHOUSE LN","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":"2077778155","pcpnpi":"1104613306","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6QV4KP0FN65","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","H25813","H43813","H02831","M5416","Z0000","I10","E785","F419","M25561","Z7689","M7632","L249","R300","M5117","M4726","M4316","Z87440","M4727","L820","R208","Z789","L821","S00401A","M542","M546","M9900","M9901","M9902","M9903","M25552","Z96642","K52832","B0229","R3915","G8929","R6889","J069","Z87891","M67854","I4891","I358","I4510","Z5181","I480","L438","Z1231","R002","R001","M7062","I4821"],"date":["2024-06-13","2024-06-13","2024-06-13","2023-04-12","2023-07-10","2023-11-20","2024-04-12","2024-04-12","2023-04-19","2023-04-19","2023-04-19","2023-11-27","2023-05-11","2023-06-24","2023-07-10","2023-06-06","2023-07-10","2023-06-06","2023-07-10","2023-07-17","2023-07-17","2023-07-17","2024-02-16","2023-07-17","2023-11-27","2023-11-27","2024-03-20","2024-03-20","2024-03-20","2024-03-20","2024-02-02","2024-02-02","2023-08-23","2023-10-06","2023-11-02","2023-12-11","2023-09-17","2023-12-30","2023-12-30","2024-01-11","2024-01-29","2024-01-29","2024-01-28","2024-02-08","2024-04-12","2024-02-16","2024-03-22","2024-04-10","2024-04-10","2024-06-26","2024-06-25"],"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":[["","","Terconazole 0.4 % Vag Cream Taro","","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Dexamethasone","0.5 MG","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Triamcinolone Acet 0.5 % Ointment Perrigo","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Macleods","","","Select","Select",""],["","","Losartan","25 MG","","Select","Select",""],["","","Quetiapine","50 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Tacrolimus 0.03 % Ointment Glenmark","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Encube","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Sulfamethoxazole\/Trimethoprim","800\/160 MG","","Select","Select",""],["","","Valproic Acid","","","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":""}]}]}