{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Virginia M Porter","gend":1,"currentgend":"","add":"651 SACO RD","city":"STANDISH","state":"ME","zip":"04084","dob":"1950-11-06","age":"","mstatus":"","insh":"10000054655","cliId":"","pno":"2076422259","cno":"","email":"","ename":"","eno":"","pphy":"CATHCART, SCOTT","ppno":"2077745816","pcpadd":"Intermed,84 Marginal Way Ste 700","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"651 SACO RD","madd2":"","madd3":"","mcity":"STANDISH","mstate":"ME","mzip":"04084","pcpfaxno":"","pcpnpi":"1659876571","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6DA2P55HT93","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5416","M79605","M79604","C880","Z7901","I4892","E213","N184","N2581","I151","M5431","M25551","M25552","Z952","M87059","M160","M87851","M25451","M87852","M25452","M87052","M87051","N1832","Z7902","Z01810","Z01818","Z98890","Z471","M85851","I97191","R4182","K589","D649","I10","Z96641","G4700","Z96652","I4821","E7800","M810","Z0001","H2513","N281","N185","Z1211","Z1212","H16223","H2512","C8800","C8801","H35371","H2511","E8352","D631","Z23","Z0000","Z1231","F5101","Z8719"],"date":["2023-05-09","2023-05-09","2023-05-09","2024-06-21","2024-02-29","2025-02-11","2023-09-06","2025-11-24","2024-06-21","2024-06-21","2023-06-02","2023-06-02","2024-02-21","2024-02-29","2023-09-01","2023-08-23","2023-07-06","2023-07-06","2023-07-06","2023-07-06","2024-02-21","2023-09-13","2024-11-08","2024-11-08","2024-02-15","2023-09-01","2023-09-08","2024-11-08","2023-09-08","2023-09-13","2024-02-21","2023-09-08","2023-09-08","2023-09-08","2024-11-08","2024-02-21","2024-03-05","2024-07-01","2024-05-08","2024-05-08","2025-05-12","2024-09-12","2025-01-24","2025-11-14","2025-05-28","2025-05-28","2025-12-30","2024-10-16","2024-11-20","2025-11-24","2024-09-12","2024-10-07","2023-02-06","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25"],"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":[["","","RESTASIS","","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","HYDROMORPHONE","2 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","FLUBLOK","","","Select","Select",""],["","","AMIODARONE","200 MG","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Micro Labs","","","Select","Select",""],["","","CLINDAMYCIN","300 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PREDNISONE","50 MG","","Select","Select",""],["","","CYCLOBENZAPRINE","10 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","METOPROLOL SUCC","50 MG","","Select","Select",""],["","","Loteprednol 0.2 % Ophth Susp B&L","","","Select","Select",""],["","","TIZANIDINE","4 MG","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","LOTEPREDNOL","0.002","","Select","Select",""],["","","KETOROLAC","0.005","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","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":""}]}]}