{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Arlene D Hansberger","gend":1,"currentgend":"","add":"20 SUNRISE HILL","city":"BERWICK","state":"ME","zip":"03901","dob":"1953-01-25","age":"","mstatus":"","insh":"10000043237","cliId":"","pno":"2073371333","cno":"","email":"jcheardjc@gmail.com","ename":"","eno":"","pphy":"EATON, JEFFREY","ppno":"2073849212","pcpadd":"Great Works Family Practice,57 Portland St","pcpcity":"South Berwick","pcpstate":"ME","pcpzip":"03908","pcpcounty":"","pcpid":"","pcpname":"GREAT WORKS FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 SUNRISE HILL","madd2":"","madd3":"","mcity":"BERWICK","mstate":"ME","mzip":"03901","pcpfaxno":"2073842008","pcpnpi":"1700835436","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1E08FP6TM30","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H2511","H269","I10","K810","H25811","K8032","K219","E039","E6601","K8010","E785","G4733","R300","R109","K8020","M109","R1011","R17","R933","M341","Z79899","Z1231","H2512","N3281","N3642","N8110","N952","Z0000","H6121","H25812","R6889","J209","Z0101","H16143","H5211","E7800","S8392XA","M1712","M170","H16142","L940","M5450","Z5111","C7982","C541","D6481","M898X6","T451X5A","H538","H26493","J208","K5730","R1031","R9431","R059","I700","N760","Z86010","D123","N950","B070","I340","C792","Z531","Z1211","Z800","C786","R100","R918","L570","I7091","Z452","C772","Z7183","H25813","H35361"],"date":["2023-04-05","2023-04-05","2025-06-17","2023-04-24","2023-04-05","2023-04-10","2026-01-21","2026-01-21","2023-04-11","2023-04-11","2023-04-11","2024-08-19","2023-04-26","2025-07-22","2023-04-10","2024-03-04","2023-04-08","2023-04-08","2023-04-08","2025-11-12","2025-11-12","2025-06-24","2023-06-28","2023-07-05","2023-07-05","2023-07-05","2025-10-07","2025-06-13","2023-06-06","2023-06-28","2023-10-16","2023-08-16","2025-05-22","2023-09-01","2023-09-01","2024-01-04","2024-02-05","2024-07-16","2024-04-16","2024-02-16","2024-02-16","2025-07-22","2026-02-17","2025-10-07","2026-02-13","2025-12-09","2025-12-09","2025-12-09","2025-05-06","2025-05-06","2024-10-25","2025-07-22","2025-07-22","2025-07-22","2024-10-25","2024-10-25","2024-11-22","2024-08-19","2024-08-19","2025-09-22","2024-09-10","2026-01-21","2026-01-21","2025-12-30","2024-08-19","2024-08-19","2025-11-05","2025-07-22","2026-01-08","2025-07-10","2024-08-21","2025-11-06","2025-11-05","2025-10-16","2023-03-09","2023-01-19"],"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",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","PENICILLIN VK","500 MG","","Select","Select",""],["","","LEVOTHYROXINE","50 MCG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Lupin","","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","DEXAMETHASONE","4 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","HYDROXYCHLOROQUINE","200 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","Clindamycin 1 % Gel Encube","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","DIAZEPAM","5 MG","","Select","Select",""],["","","ALLOPURINOL","100 MG","","Select","Select",""],["","","LOSARTAN","50 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","PROCHLORPERAZINE","5 MG","","Select","Select",""],["","","COLCHICINE","0.6 MG","","Select","Select",""],["","","DICYCLOMINE","20 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Apotex","","","Select","Select",""],["","","ROSUVASTATIN","5 MG","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","CLINDAMYCIN","0.01","","Select","Select",""],["","","ESTRADIOL","0.0001","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","MOXIFLOXACIN","0.005","","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":""}]}]}