{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carol A Ross","gend":1,"currentgend":"","add":"158 NORTH ST APT 121","city":"PORTLAND","state":"ME","zip":"04104","dob":"1945-02-06","age":"","mstatus":"","insh":"10000053517","cliId":"","pno":"2072324851","cno":"","email":"declined@122124.com","ename":"","eno":"","pphy":"FLORY, ELIZABETH","ppno":"2077984400","pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"158 NORTH ST APT 121","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04104","pcpfaxno":"2077984018","pcpnpi":"1659865970","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3F60KK5YE18","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":["M5412","E1142","E1140","E039","E559","M79604","I4891","I10","R918","R053","R0602","R058","R942","I080","R059","R509","J101","D485","L814","L821","E119","Z794","J189","J209","R0902","R791","M19011","M19012","E538","R062","M25511","M25512","Z8701","L304","R042","Z0100"],"date":["2023-04-05","2025-10-03","2023-05-23","2026-01-14","2025-05-29","2023-06-30","2023-06-30","2025-08-31","2023-08-24","2024-02-05","2025-08-31","2023-12-04","2023-12-13","2024-01-05","2024-12-10","2024-01-22","2024-01-22","2024-07-02","2024-07-02","2024-07-02","2026-01-14","2026-01-14","2026-02-06","2025-03-27","2025-08-31","2025-08-31","2025-05-29","2025-05-29","2025-05-29","2025-08-31","2025-05-29","2025-05-29","2026-02-06","2024-10-05","2024-09-27","2023-02-03"],"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":[["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","LEVOFLOXACIN","250 MG","","Select","Select",""],["","","ALBUTEROL\/IPRATROPIUM","3\/0.5 MG\/3","","Select","Select",""],["","","PRAVASTATIN","80 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","CAPVAXIVE","","","Select","Select",""],["","","VICTOZA PEN","","","Select","Select",""],["","","FLOVENT HFA","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","ONETOUCH ULTRA","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","BUPROPION HCL","150 MG","","Select","Select",""],["","","ONETOUCH ULTRA BLUE","","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","DULOXETINE","30 MG","","Select","Select",""],["","","Novolog Mix 70\/30 Flexpen","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","LEVOTHYROXINE","75 MCG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","Select","Select",""],["","","LOSARTAN","100 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","ATENOLOL","50 MG","","Select","Select",""],["","","BASAGLAR KWIKPEN","","","Select","Select",""],["","","BUDESONIDE\/FORMOTEROL","160\/4.5 MCG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","Freestyle Libre 2 Reader (Ref 71953-01)","","","Select","Select",""],["","","B-D ULTRA-FINE SHORT","","","Select","Select",""],["","","EUTHYROX","","","Select","Select",""],["","","Freestyle Libre 2 Sensor","","","Select","Select",""],["","","ALBUTEROL (","0.083%) 2.5","","Select","Select",""],["","","NOVOLOG MIX","","","Select","Select",""],["","","CHLORHEXIDINE","0.0012","","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":""}]}]}