{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Priscilla G Congdon","gend":1,"currentgend":"","add":"30 BISCAY LAKE SHORE","city":"BRISTOL","state":"ME","zip":"04539","dob":"1950-07-20","age":"","mstatus":"","insh":"10000042848","cliId":"","pno":"2075636692","cno":"","email":"pcongdon@tidewater.net","ename":"","eno":"","pphy":"LINVILLE, CORTNEY","ppno":"2078826008","pcpadd":"Wiscasset Family Health,66 Water St","pcpcity":"Wiscasset","pcpstate":"ME","pcpzip":"04578","pcpcounty":"","pcpid":"","pcpname":"WISCASSET FAMILY HEALTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"30 BISCAY LAKE SHORE","madd2":"","madd3":"","mcity":"BRISTOL","mstate":"ME","mzip":"04539","pcpfaxno":"2078827803","pcpnpi":"1366559957","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1V38VR0NW68","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","Z1231","N6315","N6313","L650","D492","L570","C44519","R928","C50911","H401132","C50811","C50919","D259","Z9049","Z9089","R918","M170","I480","K219","G4730","E669","Z170","I10","Z5181","N6031","N6489","N610","N641","I083","Q2112","M8589","I081","I499","J45909","R4182","M25512","M7542","E039","L821","R0609","R9439","I2510","R931","I4819","Z7901","J479","R6889","Z0000","Z1211","M79671","M2041","M7741","H20011","H11431","Z79811","Z853","L819","Z85828","D489"],"date":["2024-01-09","2023-05-15","2023-05-19","2023-07-12","2023-06-01","2023-06-01","2023-09-22","2023-09-22","2023-07-12","2024-05-23","2024-06-11","2023-08-23","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2024-06-06","2023-07-20","2024-03-26","2023-08-23","2023-07-26","2023-08-23","2023-07-26","2023-12-26","2023-09-06","2023-08-23","2023-08-23","2023-08-23","2023-08-23","2023-09-08","2023-09-08","2023-09-06","2023-09-08","2023-09-10","2023-09-08","2023-12-26","2023-09-14","2023-09-14","2023-12-26","2023-09-22","2023-11-09","2023-11-27","2023-12-26","2023-11-30","2024-06-12","2023-12-26","2024-01-09","2023-08-31","2024-03-08","2024-03-08","2024-05-08","2024-05-08","2024-05-08","2024-05-01","2024-05-01","2024-05-10","2024-05-23","2024-05-28","2024-05-28","2024-06-05"],"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":[["","","Diltiazem 24Hr Er (Cd)","","","Select","Select",""],["","","Tobradex","","","Select","Select",""],["","","Levothyroxine","50 MCG","","Select","Select",""],["","","Diltiazem","120 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","Losartan","100 MG","","Select","Select",""],["","","Dorzolamide Hcl","","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","Dorzolamide 2 % Ophth Sol Fosun","","","Select","Select",""],["","","Rhopressa","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Chlorthalidone","25 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Multaq","","","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":""}]}]}