{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rita I Dick","gend":1,"currentgend":"","add":"84 PENNELL ST","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1944-08-31","age":"","mstatus":"","insh":"10000034236","cliId":"","pno":"2075766149","cno":"","email":"Declined@11302021.com","ename":"","eno":"","pphy":"PICKER, BETHANY J","ppno":"2077952800","pcpadd":"272 CONGRESS ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41013637","pcpcounty":"","pcpid":"","pcpname":"MINOT AVENUE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"84 PENNELL ST","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":"2077744625","pcpnpi":"1407952468","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3E88AW6QQ29","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","I10","E785","E119","E039","M47816","M8588","M48061","M48062","M5459","R200","M5417","M25559","S72141A","J929","Z0389","Z01810","S72001A","D62","I959","E8339","Z01818","M25551","S0990XA","W010XXA","S72141D","M8580","R278","R296","R112","M5450","R531","U071","R2689","S72009A","Z9181","R52","B349","M4306","S0085XA","B351","M79675","M79674","E1159","L603","S7290XA","M5126","M5136","M47817","F419","E162","J189","J181","Z98890","M549","W1849XA","S32038A","M8008XA","T148XXA","W19XXXA","M8008XS","M4726","M5416","H906","S32009A","J9601","M6281","J988","R509","R5381","Z043","G629","R300","J069","R1110","R309","R1032","R1031","H6120"],"date":["2023-04-11","2025-11-30","2023-09-05","2025-11-30","2025-11-30","2024-01-25","2023-05-02","2024-10-16","2025-05-20","2023-07-06","2025-03-18","2023-07-20","2023-07-24","2023-07-25","2023-07-24","2023-07-24","2023-07-25","2024-07-26","2023-07-25","2023-07-25","2023-07-25","2023-12-08","2025-04-04","2024-06-01","2023-07-24","2024-03-06","2023-08-25","2024-03-06","2024-03-06","2025-04-04","2024-06-01","2025-04-04","2025-04-04","2024-03-05","2024-03-05","2024-03-05","2025-03-13","2025-04-10","2024-01-24","2023-12-08","2026-01-07","2026-01-07","2026-01-07","2026-01-07","2023-10-18","2024-01-11","2024-01-25","2024-01-25","2024-01-25","2024-06-20","2024-02-23","2025-12-03","2024-04-16","2024-04-16","2024-06-01","2024-06-01","2024-06-01","2024-06-04","2024-06-04","2024-06-01","2024-07-02","2025-05-20","2025-06-10","2025-09-09","2024-10-16","2025-04-04","2025-04-04","2025-11-30","2025-11-30","2025-11-30","2025-04-04","2024-08-09","2025-12-17","2025-11-30","2025-04-04","2025-04-04","2025-04-04","2025-04-04","2025-08-21"],"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":[["","","HYDROXYZINE HCL","25 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","GLIMEPIRIDE","2 MG","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LEVOTHYROXINE","25 MCG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","EMBRACE TALK","","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","Embrace (L1)","","","Select","Select",""],["","","GLIPIZIDE","5 MG","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","BENAZEPRIL HCL","","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","METHOCARBAMOL","500 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","BENAZEPRIL","10 MG","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","Azelastine 0.1%","137 MCG","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","Unistik 3 Comfort (Ref At 1042)","","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","Unistik 3 Comfort (Ref At 1048)","","","Select","Select",""],["","","ACCU-CHEK AVIVA PLUS","","","Select","Select",""],["","","LEVOFLOXACIN","500 MG","","Select","Select",""],["","","UNISTIK CZT","","","Select","Select",""],["","","AZELASTINE (","0.1%) 137","","Select","Select",""],["","","EMBRACE (L","","","Select","Select",""],["","","UNISTIK","3 COMFORT","","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":""}]}]}