{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra Shatney","gend":1,"currentgend":"","add":"96 BROWN RD","city":"POWNAL","state":"ME","zip":"04069","dob":"1947-11-23","age":"","mstatus":"","insh":"10000019757","cliId":"","pno":"2075043494","cno":"","email":"Wasme46@gmail.com","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"96 BROWN RD","madd2":"","madd3":"","mcity":"POWNAL","mstate":"ME","mzip":"04069","pcpfaxno":"","pcpnpi":"","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9QQ1AK5JJ18","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E034","R635","R601","E039","M3500","R0602","Z79899","R609","E785","R188","R591","I872","I7121","I739","E538","K429","N281","R590","E83110","R6889","R21","L923","L718","L821","M7910","Z0000","T300","M542","M50322","M47812","R600","M25871","M76821","Q798","M19071","M25571","H43813","H04123","H4911","I350","I083","I77810","I5032","R0609","I890","Z1231","R269","M25579","M549","R0789","R079"],"date":["2023-04-04","2023-04-04","2023-04-07","2024-04-19","2024-04-19","2023-04-10","2024-04-19","2023-12-28","2024-02-22","2023-05-26","2023-05-17","2023-06-30","2024-03-25","2023-06-30","2024-02-22","2023-05-26","2023-05-26","2023-09-14","2024-02-22","2023-06-05","2023-09-14","2023-09-14","2023-09-14","2023-09-14","2023-11-10","2024-02-22","2023-11-28","2024-01-31","2024-01-04","2024-01-04","2024-02-22","2024-06-12","2024-06-12","2024-03-04","2024-03-04","2024-06-17","2024-03-11","2024-03-11","2024-03-11","2024-03-25","2024-03-25","2024-03-25","2024-03-25","2024-03-25","2024-05-06","2024-05-21","2024-06-17","2024-06-12","2024-06-12","2024-07-01","2024-07-01"],"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":[["","","Pravastatin","10 MG","","Select","Select",""],["","","Plaquenil","","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Losartan","100 MG","","Select","Select",""],["","","Hydroxychloroquine","200 MG","","Select","Select",""],["","","Doxycycline Ir-Dr","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Nitroglycerin","0.1 MG","","Select","Select",""],["","","Doxycycline Hyclate","20 MG","","Select","Select",""],["","","Diltiazem","300 MG","","Select","Select",""],["","","Doxycycline Monohydrate","40 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":""}]}]}