{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda O Allen","gend":1,"currentgend":"","add":"165 CLEVETRIPP RD","city":"POLAND","state":"ME","zip":"04274","dob":"1948-01-15","age":"","mstatus":"","insh":"10000031447","cliId":"","pno":"2073316890","cno":"2073316890","email":"loa@roadrunner.com","ename":"","eno":"","pphy":"SLOCUM, BENJAMIN","ppno":"2076573308","pcpadd":"Gray Family Health Center,126 Shaker Rd","pcpcity":"Gray","pcpstate":"ME","pcpzip":"04039","pcpcounty":"","pcpid":"","pcpname":"GRAY FAMILY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"165 CLEVETRIPP RD","madd2":"","madd3":"","mcity":"POLAND","mstate":"ME","mzip":"04274","pcpfaxno":"2076573309","pcpnpi":"1730541749","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4PR7Y07MW49","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H353131","Z0101","H35341","H16223","I10","F419","F0390","I420","Z09","I493","I38","R400","R109","K5790","Z1211","G4733","E039","I080","Z0000","Z6823","E785","Z1231","R0683","R1084","L989","L570","X32XXXA","L821","D225","D485","C44622","R9389","Q676","J9811","R079","R413","K2289","Z87898","K5730","K648","R001","K2950","E038","K219","Z85850","E063","M810"],"date":["2024-04-15","2024-04-15","2024-04-15","2024-04-15","2024-03-12","2024-03-12","2024-03-12","2023-08-01","2023-05-01","2023-05-01","2023-05-01","2023-05-10","2023-05-30","2023-05-30","2023-05-30","2024-06-27","2023-07-10","2023-07-07","2023-11-15","2023-08-01","2023-08-01","2023-08-24","2023-09-01","2023-12-28","2023-10-17","2024-01-09","2024-01-09","2024-01-09","2024-01-09","2023-10-04","2023-11-07","2023-10-10","2023-10-10","2023-10-10","2023-10-10","2023-11-17","2023-10-17","2023-10-17","2023-09-07","2023-09-07","2023-10-10","2023-12-28","2024-03-22","2024-03-12","2024-03-25","2024-03-25","2024-03-25"],"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",""],["","","Levoxyl","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Losartan","25 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Sertraline","25 MG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Paxlovid","300\/100 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Levothyroxine","100 MCG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Donepezil","10 MG","","Select","Select",""],["","","Memantine","5 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":""}]}]}