{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia A Silva","gend":1,"currentgend":"","add":"224 WALNUT STREET","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1936-04-28","age":"","mstatus":"","insh":"10000046076","cliId":"","pno":"2077995478","cno":"","email":"","ename":"","eno":"","pphy":"EMERY, PETER","ppno":"2077745816","pcpadd":"100 FODEN RD WEST,STE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"224 WALNUT STREET","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":"2078741483","pcpnpi":"1649239765","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1FR0H76FP23","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L304","L821","D225","D485","C4492","Z0000","Z23","I10","E785","H903","L239","Z85828","S4991XA","L309","W19XXXA","M25561","S8001XA","S0990XA","Z043","G319","R350","R5383","R7309","E1165"],"date":["2023-06-12","2023-06-12","2023-06-12","2023-06-12","2023-06-12","2023-10-18","2023-10-18","2024-06-24","2024-06-24","2023-10-23","2023-11-07","2023-11-07","2023-11-01","2023-11-01","2023-11-01","2024-05-30","2024-05-30","2024-05-30","2024-05-30","2024-05-30","2024-06-18","2024-06-18","2024-06-18","2024-06-24"],"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":[["","","Nyamyc","","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Onetouch Delica Safety Lancet","","","Select","Select",""],["","","Onetouch Delica Plus","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Cefpodoxime","200 MG","","Select","Select",""],["","","Donepezil","10 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Onetouch Verio","","","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":""}]}]}