{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan Orsato","gend":1,"currentgend":"","add":"39 MILLER ST","city":"BELFAST","state":"ME","zip":"04915","dob":"1947-04-08","age":"","mstatus":"","insh":"10000017810","cliId":"","pno":"7816962326","cno":"","email":"Sorsato099@gmail.com","ename":"","eno":"","pphy":"GILLIGAN, SAMANTHA P","ppno":"2073386900","pcpadd":"Seaport Community Health Center, 29 Schoodic Dr","pcpcity":"Belfast","pcpstate":"ME","pcpzip":"04915","pcpcounty":"","pcpid":"","pcpname":"SEAPORT COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"39 MILLER ST","madd2":"","madd3":"","mcity":"BELFAST","mstate":"ME","mzip":"04915","pcpfaxno":"2073386944","pcpnpi":"1689079279","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8XD4RQ7WV87","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","H348310","H40013","Z961","H35033","F900","Z0000","I10","H34239","I6521","R6889","Z1231","R0789","I6523","M2041","R748","M2011","A499","K439","H35363","R053","Z1211","D124","M85859","M8588","L853","L578","L821","F418","Z13220","H349","R1011","K838","R7989","M8589","Z23","D485","I781","L738","Z87891","L0390","S51831D","S51831A","Z131","H17811","H348112"],"date":["2026-03-11","2026-03-11","2026-03-26","2026-03-11","2024-07-18","2024-08-30","2026-02-20","2026-02-20","2024-01-25","2024-03-04","2023-01-01","2025-09-08","2026-03-24","2024-02-20","2026-01-22","2024-10-02","2026-01-22","2024-06-23","2023-08-02","2025-01-06","2023-09-18","2025-10-09","2025-10-09","2025-09-08","2025-09-08","2025-08-27","2025-08-27","2025-08-27","2026-02-17","2026-02-20","2023-08-14","2024-10-02","2024-10-02","2024-10-02","2023-08-29","2023-10-03","2023-07-25","2023-07-25","2023-07-25","2023-07-13","2023-06-17","2023-06-21","2023-06-10","2023-05-31","2023-05-16","2023-05-16"],"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":[["","","Dextroamphet\/Amphet","10 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Abrysvo W\/ Diluent Syringe","","","Select","Select",""],["","","Lisinopril","5 MG","","Select","Select",""],["","","M-M-R Ii","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Encube","","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Aurobindo","","","Select","Select",""],["","","Isosorbide Mononitrate","30 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Adderall Xr","","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Capvaxive","","","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":""}]}]}