{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy E Dauenhauer","gend":1,"currentgend":"","add":"59 GAIL LN","city":"Yarmouth","state":"ME","zip":"04096","dob":"1951-05-10","age":"","mstatus":"","insh":"10000048624","cliId":"","pno":"4082214506","cno":"","email":"nancyellen51@yahoo.com","ename":"","eno":"","pphy":"KIM, REGINA Y","ppno":"2075351340","pcpadd":"MERCY WEST FALMOUTH PRIMARY CARE,75 GRAY RD","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"04105","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"59 GAIL LN","madd2":"","madd3":"","mcity":"Yarmouth","mstate":"ME","mzip":"04096","pcpfaxno":"2075351358","pcpnpi":"1104906155","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1UR3V38RW89","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":["E113393","E119","Z794","Z7984","E039","I10","B351","E1159","B353","E1149","M5136","E781","Z1231"],"date":["2023-07-11","2024-04-09","2023-07-10","2023-10-02","2024-04-09","2024-04-09","2023-11-14","2023-11-14","2023-11-14","2023-11-14","2023-11-09","2024-04-15","2024-05-13"],"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":[["","","Fluocinolone 0.01 % Otic Oil Rising","","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Metformin Hcl Er","","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Levothyroxine","125 MCG","","Select","Select",""],["","","Lisinopril\/Hydrochlorothiazide","20\/25 MG","","Select","Select",""],["","","Losartan","100 MG","","Select","Select",""],["","","Trulicity","","","Select","Select",""],["","","Clotrimazole 1 % Cream Taro","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Freestyle Libre 14 Day Sensor (Ref 71940-0","","","Select","Select",""],["","","Ultra-Fine (Ref 320109)","","","Select","Select",""],["","","Lantus Solostar","","","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":""}]}]}