{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sherma F Allen","gend":1,"currentgend":"","add":"813 SHAPLEIGH CORNER RD","city":"Shapleigh","state":"ME","zip":"04076","dob":"1947-02-21","age":"","mstatus":"","insh":"10000015754","cliId":"","pno":"2074599989","cno":"","email":"","ename":"","eno":"","pphy":"GIBSON, AMANDA R","ppno":"","pcpadd":"MaineHealth Primary Care Family Medicine,25A June St Ste 111","pcpcity":"Sanford","pcpstate":"ME","pcpzip":"04073","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2073245246","add2":"","add3":"","madd1":"813 SHAPLEIGH CORNER RD","madd2":"","madd3":"","mcity":"Shapleigh","mstate":"ME","mzip":"04076","pcpfaxno":"","pcpnpi":"1356796353","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9GV1D21UP16","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79604","M5430","L570","L814","L820","R079","I4891","I499","R0789","Z7901","Z87891","I480","I080","I4819","Z1231","I483","E785","I10","E669","Z0000","D6869","E7800","M5431","R030","I4720","I493","Z0101","H524","H16223","H26493"],"date":["2023-05-09","2023-05-09","2024-05-14","2023-05-11","2023-05-11","2023-05-11","2023-05-12","2023-05-12","2023-05-11","2024-03-13","2023-05-11","2024-03-13","2024-04-12","2024-05-13","2024-07-03","2023-08-03","2023-08-02","2023-08-02","2023-08-02","2024-07-01","2023-09-13","2023-09-13","2023-10-05","2024-03-13","2024-05-13","2024-05-13","2024-07-11","2024-07-11","2024-07-11","2024-07-11"],"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":[["","","Furosemide","20 MG","","Select","Select",""],["","","Xarelto","","","Select","Select",""],["","","Pravastatin","80 MG","","Select","Select",""],["","","Levothyroxine","88 MCG","","Select","Select",""],["","","Clobetasol\/Emollient 0.05 % Cream Taro","","","Select","Select",""],["","","Digoxin","0.125 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Azithromycin","250 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":""}]}]}