{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ellen L Oroak","gend":1,"currentgend":"","add":"39 MILL ST","city":"Raymond","state":"ME","zip":"04071","dob":"1952-03-16","age":"","mstatus":"","insh":"10000053984","cliId":"","pno":"2076932986","cno":"","email":"seaglass449@gmail.com","ename":"","eno":"","pphy":"GLASSPOOL, NORA G","ppno":"2078731181","pcpadd":"31 FRONT ST,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49016626","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"39 MILL ST","madd2":"","madd3":"","mcity":"Raymond","mstate":"ME","mzip":"04071","pcpfaxno":"2078731186","pcpnpi":"1275820250","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9VC5NU0GX40","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":["E785","R079","R053","R0982","R0789","I700","I209","E7800","I10","I447","I340","G40109","I25119","R931","Z8249","I200","I25110","I2111","I2510","I428","E039","E559","Z23","Z1231","R569"],"date":["2023-11-10","2024-07-08","2023-06-20","2023-06-20","2023-05-14","2023-05-15","2023-05-05","2024-04-16","2024-04-16","2023-05-04","2023-05-05","2024-05-03","2023-05-12","2023-05-12","2023-05-12","2023-05-16","2023-05-15","2023-05-12","2024-04-16","2023-06-26","2023-11-10","2023-11-10","2023-11-14","2024-02-06","2024-05-03"],"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":[["","","Levetiracetam","500 MG","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Levothyroxine","50 MCG","","Select","Select",""],["","","Abrysvo W\/ Diluent Syringe","","","Select","Select",""],["","","Isosorbide Mononitrate","30 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Rosuvastatin","40 MG","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Advair Hfa","","","Select","Select",""],["","","Valacyclovir","1 GM","","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":""}]}]}