{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ione M Reid","gend":1,"currentgend":"","add":"190 BRIER LN","city":"WEST FARMINGTON","state":"ME","zip":"04992","dob":"1947-09-13","age":"","mstatus":"","insh":"10000018976","cliId":"","pno":"2077786703","cno":"","email":"reid@tds.net","ename":"","eno":"","pphy":"HAMILTON, DEBORAH J","ppno":"2078604090","pcpadd":"Franklin Health Primary Care,131 Franklin Health Commons","pcpcity":"Farmington","pcpstate":"ME","pcpzip":"04938","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 5","madd2":"","madd3":"","mcity":"WEST FARMINGTON","mstate":"ME","mzip":"04992","pcpfaxno":"2078604098","pcpnpi":"1952334864","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1Y18XC6RT44","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J449","I351","F17210","Z7951","Z9981","M25561","M1711","M9903","G541","M9901","M9902","Z0101","Z1231","Z0000","R6889","M85852","M5450","M25552","J439","Z87891","R197"],"date":["2024-06-12","2023-09-19","2023-08-21","2024-06-12","2024-06-12","2023-09-14","2023-09-14","2024-05-24","2024-05-24","2024-05-24","2024-05-24","2023-10-24","2023-10-26","2024-04-09","2023-10-24","2023-10-26","2024-03-03","2024-03-03","2024-06-12","2024-06-12","2024-06-20"],"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":[["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Abrysvo Act-O-Vial","","","Select","Select",""],["","","Rosuvastatin","5 MG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Sucralfate","1 GM","","Select","Select",""],["","","Diltiazem 24Hr Er (Cd)","","","Select","Select",""],["","","Ipratropium 0.06 % Nas Spray Advagen","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Doxazosin","2 MG","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Estradiol","0.5 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Dicyclomine","20 MG","","Select","Select",""],["","","Famotidine","20 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":""}]}]}