{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George W Sibley","gend":0,"currentgend":"","add":"97 RIVER RD","city":"LAGRANGE","state":"ME","zip":"04453","dob":"1968-10-28","age":"","mstatus":"","insh":"10000049910","cliId":"","pno":"2077325659","cno":"","email":"Mellygeo93@gmail.com","ename":"","eno":"","pphy":"KLOSOWSKI, KYLE","ppno":"2079746700","pcpadd":"Health Access Network,175 W Broadway","pcpcity":"Lincoln","pcpstate":"ME","pcpzip":"04457","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"97 RIVER RD","madd2":"","madd3":"","mcity":"LAGRANGE","mstate":"ME","mzip":"04453","pcpfaxno":"","pcpnpi":"1477231017","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9Y93GH8XP99","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":["M450","F411","R0683","E1165","L600","Z0100","G4733","R5382","N529","Z5181","H2513","H2511","H21541","Z1211","D122","D123","K319","K2100","M459","L989","M79673","E11621"],"date":["2024-06-28","2024-07-11","2023-05-07","2024-04-24","2023-07-18","2023-08-22","2024-07-12","2023-12-18","2023-12-21","2024-04-23","2024-01-16","2024-02-21","2024-02-21","2024-02-13","2024-02-13","2024-02-13","2024-02-13","2024-03-06","2024-04-23","2024-04-24","2024-06-14","2024-07-12"],"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","40 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Pacific","","","Select","Select",""],["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Mounjaro","","","Select","Select",""],["","","Humira Pen","","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Trulicity","","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Bupropion Hcl","150 MG","","Select","Select",""],["","","Allopurinol","300 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Venlafaxine","150 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Moxifloxacin Pf 0.5 % Ophth Sol Upsher-Smi","","","Select","Select",""],["","","Ozempic","","","Select","Select",""],["","","Prevnar 20","","","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":""}]}]}