{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rachel A Cloutier","gend":1,"currentgend":"","add":"65 FOCH ST","city":"LEWISTON","state":"ME","zip":"04240","dob":"1952-05-12","age":"","mstatus":"","insh":"10000054528","cliId":"","pno":"2077400288","cno":"","email":"","ename":"","eno":"","pphy":"SHEIKH, MUHAMMAD A","ppno":"","pcpadd":"1100 TRANCAS ST STE 256,","pcpcity":"NAPA","pcpstate":"CA","pcpzip":"94558292","pcpcounty":"","pcpid":"","pcpname":"ST MARYS MEDICAL ASSOCIATES","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"65 FOCH ST","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":"7072511706","pcpnpi":"1235252859","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4QW6MF8UC77","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25561","Z0000","E1122","E782","Z23","N1830","Z96651","E119","H26493","I10","S299XXA","S0990XA","M79642","S62172A","S62175D","N6341","N1832","S62175K","N6001","M1812","S62175A","W010XXA","S6992XA","S60212D"],"date":["2024-03-01","2024-04-25","2024-04-25","2024-02-05","2023-04-19","2023-04-19","2023-05-22","2023-10-20","2024-02-08","2024-02-05","2024-04-09","2024-04-09","2024-04-16","2024-04-16","2024-05-21","2024-05-08","2024-04-25","2024-05-07","2024-05-08","2024-05-21","2024-04-16","2024-04-09","2024-05-21","2024-05-21"],"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":[["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Benazepril","40 MG","","Select","Select",""],["","","Sulfamethoxazole\/Trimethoprim","800\/160 MG","","Select","Select",""],["","","Metformin","500 MG","","Select","Select",""],["","","Ciprofloxacin Hcl","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Jardiance","","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","Amlodipine","5 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":""}]}]}