{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Vicky L Underwood","gend":1,"currentgend":"","add":"386 SOUTH HIGH ST","city":"BRIDGTON","state":"ME","zip":"04009","dob":"1952-08-23","age":"","mstatus":"","insh":"10000056423","cliId":"","pno":"2076478202","cno":"","email":"declined@04022025.com","ename":"","eno":"","pphy":"LAPHAM, DAVID A","ppno":"2077446444","pcpadd":"Western Maine Primary Care,8 Pikes Hill Rd","pcpcity":"Norway","pcpstate":"ME","pcpzip":"04268","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY AND INTERNAL MEDIC","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"386 SOUTH HIGH ST","madd2":"","madd3":"","mcity":"BRIDGTON","mstate":"ME","mzip":"04009","pcpfaxno":"2077436306","pcpnpi":"1548765753","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1UF9G17TJ59","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N200","K8020","N281","R3129","R310","H3563","Z0000","M85859","I6523","M8580","Z1211","K5900","K5730","R109","M25511","N135","F17200","J449","E785","Z466","R748","E8352","R0781","R937","F1020","Z1231","F17210","R911","Z87442","Z13220"],"date":["2024-03-22","2023-06-29","2024-02-26","2023-04-04","2023-07-13","2023-04-26","2024-04-30","2023-05-08","2023-05-08","2023-05-11","2024-05-10","2023-08-30","2023-06-21","2023-08-30","2023-06-29","2023-07-13","2024-01-10","2023-07-13","2023-07-13","2023-07-26","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-10-31","2024-01-10","2024-01-10","2024-01-22","2024-02-26","2024-04-30"],"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":[["","","Stiolto Respimat","","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Fluconazole","200 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Potassium Cl","20 MEQ","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Jardiance","","","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":""}]}]}