{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbara T Bartash","gend":1,"currentgend":"","add":"525 WHEELER ST","city":"RUMFORD","state":"ME","zip":"04276","dob":"1947-01-11","age":"","mstatus":"","insh":"10000019630","cliId":"","pno":"2073646763","cno":"","email":"","ename":"","eno":"","pphy":"KRECKEL, DIETER","ppno":"2073690146","pcpadd":"430 FRANKLIN ST,","pcpcity":"RUMFORD","pcpstate":"ME","pcpzip":"42762104","pcpcounty":"","pcpid":"","pcpname":"SWIFT RIVER FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"238 FRANKLIN ST","madd2":"","madd3":"","mcity":"Rumford","mstate":"ME","mzip":"04276","pcpfaxno":"2073648626","pcpnpi":"1912979402","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9TW5J05JG91","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","R300","I10","R309","L03032","I70201","Z452","N19","I70245","L89623","E46","K862","I4891","T82868A","K315","K255","Z931","Z9049","R5381","M86172","F419","M79672","Z7409","R531","I70202","Z95828","M879","R1084","Z01818","L97529","Z4781","M19072","G8929","I739","M869","D649","E538","E559","E640","Z5189","L089","T8149XA","I70222","S91302A","Z98890","R109","Z4801","Z48815","K9189","M8610","F410","N739","D72829","T8189XA","S81802A","S91309A","N200","N281","R195","N3289","L0390","M87052","K631","K8590","N132","K269","I774","R32","Z431","I4820","M25552","K256","K251","A419","E876","Z743","K6389","S72092A","R6521","B999","K311"],"date":["2024-05-15","2023-09-28","2025-10-13","2023-11-15","2025-10-13","2025-10-21","2025-10-29","2025-10-29","2025-10-21","2025-10-21","2025-10-21","2025-10-21","2025-10-16","2025-10-21","2025-09-13","2025-09-13","2025-09-13","2025-09-13","2025-08-03","2025-10-23","2025-10-14","2025-10-14","2025-10-14","2025-06-22","2025-11-12","2025-11-12","2025-06-12","2025-06-22","2025-10-16","2025-10-15","2025-12-01","2025-10-14","2025-12-16","2026-02-11","2025-12-16","2025-11-01","2025-11-01","2025-11-01","2025-11-01","2025-12-15","2025-10-15","2025-10-13","2025-10-18","2026-01-04","2025-08-15","2025-08-15","2026-01-17","2025-09-10","2025-08-15","2025-10-14","2025-10-14","2025-07-01","2025-07-21","2026-01-04","2025-12-31","2026-01-21","2025-06-12","2025-06-12","2025-06-12","2025-06-12","2026-01-21","2025-06-16","2025-07-11","2025-06-12","2025-07-05","2025-07-02","2025-06-22","2023-03-21","2025-12-22","2025-12-18","2025-06-12","2025-07-11","2025-06-29","2025-07-28","2025-06-24","2025-06-12","2025-07-15","2025-07-28","2025-07-28","2025-07-09","2025-06-22"],"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":[["","","HYDROXYZINE HCL","25 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","SUCRALFATE","1 GM","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","METOPROLOL TART","50 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","ESOMEPRAZOLE MAG","40 MG","","Select","Select",""],["","","Santyl","","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","Ammonium Lac 12 % Cream Taro","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","500\/125 MG","","Select","Select",""],["","","LANSOPRAZOLE","30 MG","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","ROSUVASTATIN","10 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","AMMONIUM LAC","0.12","","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":""}]}]}