{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peggy L Carr","gend":1,"currentgend":"","add":"57 LISA ST","city":"PALMYRA","state":"ME","zip":"04965","dob":"1950-08-24","age":"","mstatus":"","insh":"10000041917","cliId":"","pno":"2073201950","cno":"","email":"pegacs2017@gmail.com","ename":"","eno":"","pphy":"WYMAN, PEGGY","ppno":"","pcpadd":"DFD Russell Medical Center,11 Academy Rd","pcpcity":"Monmouth","pcpstate":"ME","pcpzip":"04259","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"57 LISA ST","madd2":"","madd3":"","mcity":"PALMYRA","mstate":"ME","mzip":"04965","pcpfaxno":"2075242093","pcpnpi":"1073592283","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4DN0CE0PK17","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":["M9901","G44209","M4802","M47812","M79646","R197","Z1211","K5730","K640","Z0000","E119","I82629","E785","E039","Z136","K589","H40011","M2550","M47816","M5137","M4186","M549","M25551","M1990","M79643","M25559","R6889","M65332","N760","R10811","R10813","R1011","R1031","R109","K5900","Z1231","N6489","E7800","S56414A","Z4789","Z4889"],"date":["2024-06-10","2024-06-10","2024-06-10","2024-06-10","2023-06-15","2023-09-20","2023-08-02","2023-08-02","2023-08-02","2023-08-08","2024-02-08","2023-08-08","2024-02-08","2024-02-08","2023-07-31","2024-02-08","2024-04-11","2023-10-04","2023-10-04","2023-10-04","2023-10-04","2023-10-04","2023-10-04","2023-10-04","2023-10-04","2023-10-04","2023-09-26","2024-05-13","2023-11-29","2024-01-17","2024-01-17","2024-01-17","2024-01-17","2024-01-19","2024-01-19","2024-01-31","2024-02-05","2024-02-05","2024-03-07","2024-05-14","2024-06-25"],"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":[["","","Clobetasol 0.05 % Ointment Taro","","","Select","Select",""],["","","Accu-Chek Guide","","","Select","Select",""],["","","Levothyroxine","50 MCG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Rosuvastatin","5 MG","","Select","Select",""],["","","Bupropion Hcl","150 MG","","Select","Select",""],["","","Bupropion Hcl Sr","","","Select","Select",""],["","","Dicyclomine","20 MG","","Select","Select",""],["","","Bisoprolol","5 MG","","Select","Select",""],["","","Leader","","","Select","Select",""],["","","Meloxicam","15 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":""}]}]}