{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth J Herrick","gend":1,"currentgend":"","add":"29 ORESTIS WAY","city":"LEWISTON","state":"ME","zip":"04240","dob":"1949-12-26","age":"","mstatus":"","insh":"10000048457","cliId":"","pno":"2077543375","cno":"","email":"declined@01082026.com","ename":"","eno":"","pphy":"LATKOVICH, KATARINA Z","ppno":"2077955700","pcpadd":"12 HIGH ST,STE 400 CENTRAL MAINE INTERNAL MEDICINE","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"29 ORESTIS WAY","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":"2077955727","pcpnpi":"1902878499","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1RK2K30NV03","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R21","J45909","J449","R030","L270","Z720","T50905D","R5383","R911","E785","E039","F17210","Z0000","H40013","H43812","Z780","M810","Z1231","H903","H9313","J4489","J309","R0602","R918"],"date":["2023-05-25","2024-04-15","2024-03-25","2023-04-03","2023-05-22","2023-05-22","2023-05-25","2023-09-18","2024-04-15","2023-09-18","2023-09-18","2024-04-15","2023-09-18","2024-01-19","2024-01-19","2024-02-07","2024-02-07","2024-02-07","2024-02-28","2024-02-28","2024-04-15","2024-06-28","2024-06-19","2024-06-19"],"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":[["","","Budesonide","0.5 MG","","Select","Select",""],["","","Albuterol\/Ipratropium","3\/0.5 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","Rosuvastatin","20 MG","","Select","Select",""],["","","Ibandronate","150 MG","","Select","Select",""],["","","Fluticasone Prop\/Salmeterol","500\/50 MCG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Levothyroxine","88 MCG","","Select","Select",""],["","","Fasenra Pen","","","Select","Select",""],["","","Wixela Inhub","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Dupixent","","","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":""}]}]}