{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carol P Bryan","gend":1,"currentgend":"","add":"496 SHORE ROAD","city":"PERRY","state":"ME","zip":"04667","dob":"1947-01-24","age":"","mstatus":"","insh":"10000024572","cliId":"","pno":"2078534015","cno":"","email":"declined@051325.com","ename":"","eno":"","pphy":"LUTHIN, SUSAN L","ppno":"","pcpadd":"118 MOOSEHEAD TRL,STE 5","pcpcity":"NEWPORT","pcpstate":"ME","pcpzip":"49534055","pcpcounty":"","pcpid":"","pcpname":"EASTPORT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"496 SHORE ROAD","madd2":"","madd3":"","mcity":"PERRY","mstate":"ME","mzip":"04667","pcpfaxno":"2073684213","pcpnpi":"1356383962","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3FE2UN5WT06","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R002","I10","E039","Z0000","E785","I4891","I493","I2720","H401131","I491","I471","M810","Z23","K589","E739","M4185","M47895","M2170","M5450","M4316","M4186","S22069A","S22079A","E041","I350","D3131","D485","L570","L578","L821","Z1231"],"date":["2023-04-13","2024-05-28","2024-05-28","2024-06-05","2024-05-28","2024-01-25","2023-06-15","2023-06-15","2024-03-06","2023-07-26","2023-07-26","2024-07-03","2024-01-22","2023-12-13","2023-12-13","2023-12-14","2023-12-14","2023-12-14","2024-02-16","2023-10-26","2023-10-26","2023-10-26","2023-10-26","2024-01-05","2023-12-21","2024-03-06","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-07-03"],"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":[["","","Valacyclovir","500 MG","","Select","Select",""],["","","Levothyroxine","50 MCG","","Select","Select",""],["","","Clobetasol 0.05 % Shampoo Amneal","","","Select","Select",""],["","","Diltiazem","120 MG","","Select","Select",""],["","","Tiadylt Er","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Greenstone","","","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":""}]}]}