{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cheryl L Crafts","gend":1,"currentgend":"","add":"52 RIDGE RD","city":"LISBON FALLS","state":"ME","zip":"04252","dob":"1950-10-24","age":"","mstatus":"","insh":"10000051078","cliId":"","pno":"","cno":"2075773661","email":"clcrafts@hotmail.com","ename":"","eno":"","pphy":"SALKO, DAVID L","ppno":"2077986200","pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2073536422","add2":"","add3":"","madd1":"52 RIDGE RD","madd2":"","madd3":"","mcity":"LISBON FALLS","mstate":"ME","mzip":"04252","pcpfaxno":"2078741483","pcpnpi":"1659338879","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XW4P22WD68","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H02055","H16042","F331","Z0101","R6889","M25532","Z043","S0512XA","S6992XA","S299XXA","S0083XA","W000XXA","Z0000","Z1211","R5383","M810","Z780","H2189","S0502XA"],"date":["2023-04-25","2023-04-28","2024-06-03","2023-09-12","2023-09-12","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2024-03-14","2024-03-15","2024-03-14","2024-03-25","2024-03-25","2024-03-18","2024-03-13"],"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":[["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Dextroamphet\/Amphet","10 MG","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Tobramycin\/Dex 0.3\/0.1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Micro Labs","","","Select","Select",""],["","","Methylphenidate","10 MG","","Select","Select",""],["","","Difluprednate 0.05 % Ophth Emuls Upsher-Sm","","","Select","Select",""],["","","Lisinopril","20 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":""}]}]}