{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stanwood W Waterhouse","gend":0,"currentgend":"","add":"56 WILDERNESS DRIVE","city":"MEDWAY","state":"ME","zip":"04460","dob":"1950-06-15","age":"","mstatus":"","insh":"10000048072","cliId":"","pno":"2077469410","cno":"","email":"aldridgehouse.srrl@gmail.com","ename":"","eno":"","pphy":"GOLLETTI, JENNI L","ppno":"2077235161","pcpadd":"Millinocket Regional Hospital Family and Internal,200 Somerset St Ste 3","pcpcity":"Millinocket","pcpstate":"ME","pcpzip":"04462","pcpcounty":"","pcpid":"","pcpname":"MILLINOCKET REGIONAL HOSPITAL FAMILY AND INTERNAL","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"56 WILDERNESS DRIVE","madd2":"","madd3":"","mcity":"MEDWAY","mstate":"ME","mzip":"04460","pcpfaxno":"2077234913","pcpnpi":"1841643731","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4T09E97CH25","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","N401","R351","R350","R3589","I10","R6889","Z0000","Z79899","Z0100","N400","Z8719","K5900"],"date":["2023-07-12","2023-08-25","2023-08-25","2023-08-25","2023-10-03","2024-01-03","2023-12-27","2024-03-14","2024-03-22","2024-03-01","2024-05-13","2024-06-14","2024-07-03"],"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":[["","","Atorvastatin","10 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Lupin","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Diltiazem","180 MG","","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":""}]}]}