{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marlene A Maynard","gend":1,"currentgend":"","add":"54 PHEASANT RUN ROAD","city":"EAST WATERBORO","state":"ME","zip":"04030","dob":"1951-05-22","age":"","mstatus":"","insh":"10000048928","cliId":"","pno":"2072476972","cno":"","email":"opt-out@optout.com","ename":"","eno":"","pphy":"KOWASH, PHILIP M","ppno":"2072838800","pcpadd":"9 HEALTHCARE DRIVE,SUITE 201","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"40053747","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"54 PHEASANT RUN ROAD","madd2":"","madd3":"","mcity":"EAST WATERBORO","mstate":"ME","mzip":"04030","pcpfaxno":"2072869853","pcpnpi":"1215991773","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3QD8KP7NP42","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z96652","Z471","M542","M9901","M546","M9902","N390","R3129","K219","K449","Z85038","Z1211","K635","E785","F32A","Z0000","E6601","Z6841","F39","I10","Z4889","R350","R300","N1831","Z87891","Z0101","H524","H60501"],"date":["2023-11-30","2023-05-26","2023-07-06","2023-07-06","2023-06-21","2023-07-06","2024-01-28","2023-06-29","2023-12-11","2023-12-11","2023-10-03","2023-10-03","2023-10-03","2023-11-13","2023-10-03","2023-10-18","2023-10-18","2023-10-18","2024-05-08","2024-05-08","2024-01-05","2024-01-28","2024-01-28","2024-06-12","2024-05-08","2024-06-06","2024-06-06","2024-06-04"],"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":[["","","Hydromorphone","2 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Triamterene\/Hydrochlorothiazide","37.5\/25 MG","","Select","Select",""],["","","Bupropion Hcl","150 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":""}]}]}