{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna L Mckinnon","gend":1,"currentgend":"","add":"112 MOUNTAIN RD","city":"Woolwich","state":"ME","zip":"04579","dob":"1947-11-12","age":"","mstatus":"","insh":"10000037189","cliId":"","pno":"2074432146","cno":"","email":"hewey@myfairpoint.net","ename":"","eno":"","pphy":"GLASSPOOL, NORA G","ppno":"2078731181","pcpadd":"31 FRONT ST,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49016626","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"112 MOUNTAIN RD","madd2":"","madd3":"","mcity":"Woolwich","mstate":"ME","mzip":"04579","pcpfaxno":"2078731186","pcpnpi":"1275820250","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7DQ0F76YG06","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5412","M25511","M1712","M170","M1711","C519","S99921A","M75101","M151","M20031","G8929","M8580","Z13220","E559","Z1211","Z23","M20011","M19041","Z1231","E6601","M810","R1031","R195","N200","K5730","K449","N2889","N814","N812","N3946","N901"],"date":["2023-10-03","2023-10-03","2023-09-11","2023-09-11","2023-05-18","2024-05-29","2023-09-11","2023-09-27","2023-09-27","2023-09-27","2023-10-04","2023-10-04","2023-10-04","2023-10-04","2023-10-19","2023-11-09","2024-01-11","2024-01-11","2023-11-21","2023-12-06","2023-12-06","2024-02-06","2024-01-17","2024-02-06","2024-02-06","2024-02-06","2024-02-06","2024-05-29","2024-06-12","2024-06-03","2024-06-03"],"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":[["","","Mupirocin 2 % Ointment Teva","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Pacific","","","Select","Select",""],["","","Potassium Cl","20 MEQ","","Select","Select",""],["","","Paxlovid","300\/100 MG","","Select","Select",""],["","","Azithromycin","500 MG","","Select","Select",""],["","","Klor-Con M20","","","Select","Select",""],["","","Citalopram","20 MG","","Select","Select",""],["","","Silver Sulfadiazine 1 % Cream Ascend Labs","","","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":""}]}]}