{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marilyn J Drew","gend":1,"currentgend":"","add":"11 MUIRFIELD DR","city":"Bridgton","state":"ME","zip":"04009","dob":"1949-01-11","age":"","mstatus":"","insh":"10000032560","cliId":"","pno":"2076479655","cno":"","email":"declined@email.com","ename":"","eno":"","pphy":"JOLICOEUR, MYRIAM","ppno":"2076936106","pcpadd":"76 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"NAPLES FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 MUIRFIELD DR","madd2":"","madd3":"","mcity":"Bridgton","mstate":"ME","mzip":"04009","pcpfaxno":"2076934026","pcpnpi":"1316433667","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8V65MQ2TW52","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R6889","M25552","M7062","J432","C3490","J8410","J479","C3431","Z1231","M7061","R059","B370","K5792","Z85118","K5732","K760","J439","J181","K449","R5383","Z23","E7800","R42","E038","D122","K222","Z08","Z0000","S42211A","S42201A","S6992XA","J189","I10","J449","R399","R233","S59901A","K219"],"date":["2023-01-11","2023-04-24","2023-04-24","2025-03-28","2024-12-06","2023-05-15","2024-12-06","2023-11-13","2023-07-18","2023-10-05","2025-01-24","2023-11-01","2024-03-22","2025-06-17","2024-02-22","2023-11-10","2023-11-13","2023-11-13","2024-07-10","2023-11-15","2023-11-24","2024-02-21","2024-04-08","2024-05-10","2024-05-22","2024-07-10","2025-06-17","2024-06-13","2026-02-10","2026-02-12","2026-02-10","2025-01-24","2025-01-24","2025-01-24","2024-10-29","2024-07-15","2026-02-10","2024-07-10"],"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":[["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Potassium Cl","10 MEQ","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Advair Diskus","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Levothyroxine","25 MCG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Hydrochlorothiazide","25 MG","","Select","Select",""],["","","Hydrocodone\/Acetaminophen","5\/325 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Fluticasone Prop\/Salmeterol","250\/50 MCG","","Select","Select",""],["","","Ventolin Hfa","","","Select","Select",""],["","","Wixela Inhub","","","Select","Select",""],["","","Abrysvo W\/ Diluent Syringe","","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Nystatin 100","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}