{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cornelia W Tibbals","gend":1,"currentgend":"","add":"15 PIPER RD APT J321","city":"Scarborough","state":"ME","zip":"04074","dob":"1938-08-26","age":"","mstatus":"","insh":"10000024006","cliId":"","pno":"2078859669","cno":"","email":"tdktibbals@gmail.com","ename":"","eno":"","pphy":"FARINO, BENEDICT J","ppno":"2078833491","pcpadd":"190 RIVERSIDE ST,SUITE 6B","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41031073","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 PIPER RD APT J321","madd2":"","madd3":"","mcity":"Scarborough","mstate":"ME","mzip":"04074","pcpfaxno":"2078855587","pcpnpi":"1104912864","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3PU6X12DT70","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H16223","I10","E785","Z0100","I447","I6523","E7800","I088","H8110","Z1231","E8352","E039","E7849","Z23","Z0000","R262","N1831","I129","R6889","Z471","Z96653","Z79899","R0609"],"date":["2023-04-25","2024-06-18","2023-05-02","2024-06-05","2024-06-18","2024-06-18","2024-05-23","2024-05-21","2023-05-26","2023-06-02","2023-07-21","2023-10-03","2023-10-03","2023-10-19","2023-10-24","2023-10-24","2023-10-24","2023-10-24","2023-05-02","2024-03-20","2024-03-20","2024-05-23","2024-06-18"],"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":[["","","Myrbetriq","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Meclizine","12.5 MG","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Epinephrine","0.3 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Triamterene\/Hydrochlorothiazide","37.5\/25 MG","","Select","Select",""],["","","Metoprolol Succ","25 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":""}]}]}