{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah P Strout","gend":1,"currentgend":"","add":"87 SOUTH ST","city":"GORHAM","state":"ME","zip":"04038","dob":"1946-05-13","age":"","mstatus":"","insh":"10000045291","cliId":"","pno":"2078396610","cno":"","email":"DSTROUT1@MAINE.RR.COM","ename":"","eno":"","pphy":"SALEMBIER, BRIGITTE","ppno":"2076613400","pcpadd":"190 RIVERSIDE ST,SUITE 6B","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41031073","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"87 SOUTH ST","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":"2076623401","pcpnpi":"1457797235","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3M18F38MU45","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A000","Z471","Z96652","M25562","M25662","Z1231","H401132","Z09","Z0000","J432","I700","I10","I5189","R011","R6889","E038","E063","Z0101","R944","M85852","N6322","R921","N6022","D242"],"date":["2023-04-02","2023-06-01","2023-04-14","2023-06-01","2023-06-01","2024-04-29","2024-01-08","2023-10-09","2023-10-18","2023-10-18","2023-10-18","2024-01-11","2023-11-10","2023-11-10","2023-01-01","2024-01-11","2024-01-11","2024-01-08","2024-03-13","2024-04-12","2024-06-04","2024-05-21","2024-06-04","2024-06-04"],"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":[["","","Hydromorphone","2 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Timolol Mal (Twice Daily) 0.5 % Ophth Sol","","","Select","Select",""],["","","Colchicine","0.6 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Levothyroxine","112 MCG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","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":""}]}]}