{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia Klein","gend":1,"currentgend":"","add":"47 N MITCHELL RD","city":"TROY","state":"ME","zip":"04987","dob":"1943-09-05","age":"","mstatus":"","insh":"10000017128","cliId":"","pno":"2079482724","cno":"","email":"","ename":"","eno":"","pphy":"CHAMBERLAIN, DEAN E","ppno":"2074379388","pcpadd":"Lovejoy Health Center,7 School St Ste 1","pcpcity":"Albion","pcpstate":"ME","pcpzip":"04910","pcpcounty":"","pcpid":"","pcpname":"LOVEJOY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"47 N MITCHELL RD","madd2":"","madd3":"","mcity":"TROY","mstate":"ME","mzip":"04987","pcpfaxno":"2078619624","pcpnpi":"1922360411","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5TN0HF6EK07","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":["E8352","M7989","M069","L409","M25572","Z79899","R911","D490","M1990","Z0189","G5132","M810","G5139","Z0000","Z0101","Z23","M25531","I10","E119","Z79620","Z7960","R918","J189","E7800","J439","I700","R0609","R0600","U071","Z7969","Z87891","J90","J479","J9811","J1281","J101","F411","J449","D649","J111","R0602","A419","J9601","D72829","D509","D75839","R051","E038","J42","H903","Z789","M0579","Z7952","D72828","R2689","R1310","R0902","M059","Z8616","J440","K449","R799","J209","J4489","J159","Z7951","R7989","J208"],"date":["2026-01-08","2023-05-01","2026-02-03","2023-05-01","2023-05-01","2025-01-28","2025-07-16","2023-05-11","2023-05-09","2023-06-01","2023-08-07","2023-06-01","2023-08-07","2025-12-31","2023-11-10","2025-12-31","2023-11-07","2025-10-01","2025-12-31","2026-02-03","2025-02-06","2025-10-02","2025-10-03","2024-06-12","2024-12-02","2024-10-11","2026-02-11","2025-11-03","2024-10-11","2026-02-03","2026-02-03","2024-12-02","2024-12-23","2024-09-28","2024-09-27","2025-04-28","2024-08-14","2025-09-24","2025-12-24","2024-09-27","2025-10-01","2025-10-03","2025-10-11","2025-04-08","2025-08-06","2024-09-29","2024-09-25","2026-02-18","2025-10-14","2025-09-12","2024-10-08","2025-10-10","2025-10-10","2026-01-28","2024-07-15","2025-10-03","2025-10-02","2025-02-06","2025-07-16","2025-10-03","2024-12-23","2025-04-08","2025-05-08","2024-12-11","2024-12-11","2024-12-11","2025-04-08","2025-05-08"],"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":[["","","AZITHROMYCIN","500 MG","","Select","Select",""],["","","LEFLUNOMIDE","20 MG","","Select","Select",""],["","","OSELTAMIVIR","75 MG","","Select","Select",""],["","","HYDROXYCHLOROQUINE","200 MG","","Select","Select",""],["","","Sure Comfort (Ref 26-3010)","","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","LOVASTATIN","20 MG","","Select","Select",""],["","","ENBREL MINI","","","Select","Select",""],["","","LISINOPRIL","5 MG","","Select","Select",""],["","","ORENCIA CLICKJECT","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","PAXLOVID (MODERATE RENAL) PACK","","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","LOSARTAN","25 MG","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","ALBUTEROL\/IPRATROPIUM","3\/0.5 MG\/3","","Select","Select",""],["","","SULFASALAZINE","500 MG","","Select","Select",""],["","","LEVOTHYROXINE","25 MCG","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","AMOXICILLIN","875 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","SURE COMFORT (REF","","","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":""}]}]}