{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Becky A Cox","gend":1,"currentgend":"","add":"160 POWERSVILLE ROAD","city":"MEDWAY","state":"ME","zip":"04460","dob":"1951-07-29","age":"","mstatus":"","insh":"10000049068","cliId":"","pno":"2077465097","cno":"","email":"brucebeckycox@gmail.com","ename":"","eno":"","pphy":"KOFFMAN, DAVID J","ppno":"2079073300","pcpadd":"C\/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT,PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"P O BOX 149","madd2":"","madd3":"","mcity":"MEDWAY","mstate":"ME","mzip":"04460","pcpfaxno":"2079071923","pcpnpi":"1164402624","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9M19NG1PM48","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1149","E1165","E11649","E1142","E1122","Z794","I129","Z45018","N184","I10","N200","Z0000","Z1231","I2510","N1831","E11319","R6889","M5431","M5432","E6601","L602","L409","M25562","G8929","D72821","M1712","I350","Z111","M85852","S81802A","E559","D6489","I081","I77810","I2720","Z952","E119","H25813","D3131","D3132","S81802D"],"date":["2023-04-05","2025-11-18","2023-05-02","2025-11-20","2025-11-18","2025-11-18","2023-05-01","2026-03-02","2025-11-04","2026-02-24","2023-05-09","2026-02-24","2025-11-07","2023-10-13","2024-05-07","2023-07-26","2023-07-26","2023-08-22","2023-12-01","2024-02-13","2024-02-06","2025-09-02","2024-03-01","2023-12-13","2024-03-12","2023-12-20","2026-01-12","2024-11-05","2025-11-07","2024-08-08","2025-11-04","2025-11-04","2026-01-12","2026-01-12","2026-01-12","2026-01-12","2025-10-10","2025-10-10","2025-10-10","2025-10-10","2024-11-13"],"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":[["","","Clobetasol 0.05 % Ointment Taro","","","Select","Select",""],["","","STELARA","","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","ALLOPURINOL","100 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","Novolin 70\/30 Flexpen","","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","EZETIMIBE","10 MG","","Select","Select",""],["","","Insulin Aspart Protamine\/Aspart 70\/30 Unit","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","PANTOPRAZOLE","20 MG","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","Ultra-Fine (Ref 320109)","","","Select","Select",""],["","","Unifine Pentips (Ref An3530)","","","Select","Select",""],["","","Clobetasol 0.05 % Ointment Encube","","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","Novolog Mix 70\/30 Flexpen","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Freestyle Libre 2 Reader (Ref 71953-01)","","","Select","Select",""],["","","B-D ULTRA-FINE SHORT","","","Select","Select",""],["","","Freestyle Libre 2 Sensor","","","Select","Select",""],["","","NOVOLIN","","","Select","Select",""],["","","CLOBETASOL","0.0005","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","ULTRA-FINE (REF","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","INSULIN ASPART PROTAMINE\/ASPART","","","Select","Select",""],["","","UNIFINE PENTIPS (REF AN","","","Select","Select",""],["","","PREVNAR","","","Select","Select",""],["","","NOVOLOG MIX","","","Select","Select",""],["","","FREESTYLE LIBRE","2 READER","","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":""}]}]}