{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brenda Stetson","gend":1,"currentgend":"","add":"9 COUNTRY WAY","city":"ROCKLAND","state":"ME","zip":"04841","dob":"1957-06-10","age":"","mstatus":"","insh":"10000017253","cliId":"","pno":"2077454380","cno":"2077454380","email":"BREN610@ROADRUNNER.COM","ename":"","eno":"","pphy":"RIPLEY, TRISTEN D","ppno":"2073015900","pcpadd":"Penobscot Bay Family Medicine,15 Anchor Dr Ste 201","pcpcity":"Rockport","pcpstate":"ME","pcpzip":"04856","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9 COUNTRY WAY","madd2":"","madd3":"","mcity":"ROCKLAND","mstate":"ME","mzip":"04841","pcpfaxno":"2073015359","pcpnpi":"1649775966","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3PR1HE2WU97","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":["Z7901","Z96643","Z09","M7602","M7632","M7062","M62830","Z1231","H401112","F17210","Z122","H409","M79641","Z23","M25552","M9905","J441","I361","I10","I2782","I77810","D6861","M79671","H401113","H401121","Z96642"],"date":["2024-07-02","2023-07-17","2023-07-17","2024-06-24","2024-06-24","2024-06-24","2023-07-21","2023-08-15","2023-09-28","2023-11-20","2023-11-20","2023-11-14","2023-11-28","2023-11-28","2024-01-09","2024-01-09","2024-01-02","2024-03-20","2024-04-05","2024-04-05","2024-04-05","2024-04-05","2024-04-11","2024-05-08","2024-05-08","2024-06-24"],"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":[["","","Enoxaparin Pf","40 MG","","Select","Select",""],["","","Lactulose","10 GM","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol B&L","","","Select","Select",""],["","","Jantoven","","","Select","Select",""],["","","Hydrochlorothiazide","12.5 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Lupin","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Rosuvastatin","10 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Tobramycin\/Dex 0.3\/0.1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Buspirone","10 MG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Constulose","","","Select","Select",""],["","","Cefpodoxime","200 MG","","Select","Select",""],["","","Linzess","","","Select","Select",""],["","","Cyclobenzaprine","10 MG","","Select","Select",""],["","","Metoprolol Succ","25 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":""}]}]}