{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Una R Hatch","gend":1,"currentgend":"","add":"65 FOREST HILL","city":"BUCKSPORT","state":"ME","zip":"04416","dob":"1947-07-29","age":"","mstatus":"","insh":"10000023561","cliId":"","pno":"2077029262","cno":"","email":"declined@03062026.com","ename":"","eno":"","pphy":"BISWAS, SHUBHRANGSHU","ppno":"2074697371","pcpadd":"BUCKSPORT REG HLTH CTR,110 BROADWAY PO BOX 447","pcpcity":"BUCKSPORT","pcpstate":"ME","pcpzip":"04416","pcpcounty":"","pcpid":"","pcpname":"BUCKSPORT REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"65 FOREST HILL","madd2":"","madd3":"","mcity":"BUCKSPORT","mstate":"ME","mzip":"04416","pcpfaxno":"2074697306","pcpnpi":"1366403412","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8AR0UM4RG27","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R1013","R112","E119","E785","I10","R9431","E1165","Z794","R1084","K261","K651","K271","K631","L814","L821","D220","Z7189","L820","L538","R208","L298","H40033","R933","K2950","K275","K319","Z8719","Z0101","E1142","M170","Z1231","Z0000"],"date":["2023-05-19","2023-05-19","2024-04-29","2024-05-04","2024-04-29","2023-05-23","2024-05-17","2024-05-17","2023-06-05","2023-06-07","2023-06-07","2023-06-14","2023-06-06","2023-06-23","2023-06-23","2023-06-23","2023-06-23","2023-06-23","2023-06-23","2023-06-23","2023-06-23","2024-03-28","2023-08-11","2023-10-11","2023-08-11","2023-10-11","2023-10-11","2023-11-16","2023-12-01","2023-12-01","2024-03-11","2024-02-17"],"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":[["","","Metoclopramide","5 MG","","Select","Select",""],["","","Chlorthalidone","25 MG","","Select","Select",""],["","","Timolol Mal (Twice Daily) 0.5 % Ophth Sol","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Basaglar Kwikpen","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Metronidazole","250 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Novolog Flexpen","","","Select","Select",""],["","","Pravastatin","80 MG","","Select","Select",""],["","","Basaglar Tempo Pen","","","Select","Select",""],["","","Diltiazem","300 MG","","Select","Select",""],["","","Losartan","100 MG","","Select","Select",""],["","","Ultra-Fine (Ref 320109)","","","Select","Select",""],["","","Lantus Solostar","","","Select","Select",""],["","","Comirnaty 2023-2024","","","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":""}]}]}