{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janice S Littlefield","gend":1,"currentgend":"","add":"24 CORMIER RD","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1943-01-09","age":"","mstatus":"","insh":"10000052008","cliId":"","pno":"2074506977","cno":"","email":"unoiamjen@msn.com","ename":"","eno":"","pphy":"CHERBULIEZ, NICOLE B","ppno":"2078742466","pcpadd":"300 SOUTHBOROUGH DR,SUITE 201","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066914","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"544 OCEAN AVE","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04103","pcpfaxno":"","pcpnpi":"1932293578","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7F81F54XA37","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","I2510","G301","E7800","F02A4","Z131","R0602","R062","M1711","M79672","M25572","M25562","M25472","M25462","I7091","B351","M79674","L602","M25561","I509"],"date":["2023-04-25","2023-08-15","2023-08-15","2023-04-25","2023-08-15","2023-04-25","2023-04-26","2023-04-26","2024-02-14","2023-10-23","2023-10-25","2023-10-25","2023-10-25","2023-10-25","2024-02-13","2024-02-13","2024-02-13","2024-02-13","2024-03-06","2024-02-26"],"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":[["","","Compro","","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Risperidone","0.5 MG","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Metoprolol Succ","25 MG","","Select","Select",""],["","","Doxepin","3 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Duloxetine","20 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Paxlovid (Moderate Renal) Pack","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Ezetimibe","10 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":""}]}]}