{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joyce E Welt","gend":1,"currentgend":"","add":"165 HILLSIDE RD","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1950-05-17","age":"","mstatus":"","insh":"10000045543","cliId":"","pno":"2077295328","cno":"","email":"GRTRAVEL42@GMAIL.COM","ename":"","eno":"","pphy":"SOMMER, JOHN E","ppno":"2077984400","pcpadd":"Martins Point Health Care,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"165 HILLSIDE RD","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":"2078287850","pcpnpi":"1275732364","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4MF8YG9EH49","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":["Z01419","N898","Z0101","Z961","H1711","R6889","Z0000","F331","Z23","L308","M5442","M9903","M5440","H26493","H01023","H01026","S52121A","M79644","M25421","M19021","M778","S60041A","R202","N393","B0052","H179","Z1231"],"date":["2024-04-18","2023-04-13","2023-06-01","2023-06-01","2023-06-01","2023-12-11","2023-10-30","2023-10-30","2023-10-30","2023-10-30","2023-10-26","2023-10-30","2023-10-30","2024-05-14","2024-03-01","2024-03-01","2024-04-22","2024-04-05","2024-04-05","2024-04-05","2024-04-05","2024-04-05","2024-04-05","2024-04-17","2024-05-14","2024-05-14","2024-05-31"],"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":[["","","Valacyclovir","500 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Clindamycin 2 % Vag Cream Fougera","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Paxlovid","300\/100 MG","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Citalopram","20 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","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":""}]}]}