{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Amy J Klainer","gend":1,"currentgend":"","add":"BEECH ST 41","city":"ROCKLAND","state":"ME","zip":"04841","dob":"1952-02-06","age":"","mstatus":"","insh":"10000054332","cliId":"","pno":"2075424227","cno":"2075424227","email":"foolsdance@gmail.com","ename":"","eno":"","pphy":"YETMAN, CORNELIUS A","ppno":"2079215800","pcpadd":"4 GLEN COVE DR,SUITE 202","pcpcity":"ROCKPORT","pcpstate":"ME","pcpzip":"48564235","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"BEECH ST 41","madd2":"","madd3":"","mcity":"ROCKLAND","mstate":"ME","mzip":"04841","pcpfaxno":"2075935322","pcpnpi":"1144415548","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7MX5PD5PP78","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4819","M5450","G8929","D489","L578","L814","D229","L918","D225","H25813","E119","Z7984","H40023","Z0000","I5021","I4891","I110","Z13820","Z86018","Z780","I63412","I083","I77810","R931","N3090","R3915","R030","F419","R300","N3000","I483","I484","I10","I4892","Z1231","N6489","R921","I491","I4710","I498"],"date":["2024-06-25","2023-04-20","2023-04-20","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2024-03-05","2024-03-05","2024-03-05","2024-05-16","2024-02-28","2024-02-02","2023-06-08","2023-12-07","2023-08-02","2023-08-09","2023-08-02","2023-08-25","2023-09-11","2023-09-11","2023-09-11","2023-09-13","2023-09-25","2023-09-25","2023-09-25","2023-11-21","2023-11-21","2023-12-07","2023-12-07","2024-02-02","2024-02-02","2024-04-11","2024-04-23","2024-04-23","2024-07-09","2024-07-09","2024-07-09"],"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":[["","","Furosemide","20 MG","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol B&L","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Metformin","500 MG","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Fosun","","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Lorazepam","1 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Boostrix","","","Select","Select",""],["","","Dofetilide","0.125 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Comirnaty 2023-2024","","","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":""}]}]}