{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Scott R Owens","gend":0,"currentgend":"","add":"233 OLD AUGUSTA RD","city":"WALDOBORO","state":"ME","zip":"04572","dob":"1953-02-01","age":"","mstatus":"","insh":"10000058965","cliId":"","pno":"2077903285","cno":"","email":"declined@021320.com","ename":"","eno":"","pphy":"STARING, KATELYN","ppno":"2078326394","pcpadd":"Mainehealth,35 Miles St","pcpcity":"Damariscotta","pcpstate":"ME","pcpzip":"04543","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"233 OLD AUGUSTA RD","madd2":"","madd3":"","mcity":"WALDOBORO","mstate":"ME","mzip":"04572","pcpfaxno":"2078324392","pcpnpi":"1831681568","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4FK5E51DT61","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","Z0000","Z23","I214","I2510","F32A","Z01818","M47814","Z01810","I6523","R911","Z48812","R918","R079","A000","J9811","I083","I340","E785","K219","Z09","E871","I2584","Z951","Z1211","Z800","K635","K5730","D123","D120","D124","D128","Z1212","K621"],"date":["2024-03-05","2024-07-08","2023-12-20","2023-11-03","2024-03-08","2023-10-30","2023-10-30","2023-10-30","2023-10-30","2023-10-30","2023-10-30","2023-11-10","2023-11-03","2023-11-04","2023-11-06","2023-11-02","2023-10-30","2023-10-31","2024-03-05","2023-10-31","2023-11-04","2023-11-03","2023-11-03","2024-03-07","2024-03-26","2024-03-26","2024-03-26","2024-03-26","2024-03-26","2024-03-06","2024-03-06","2024-03-06","2024-03-06","2024-03-06"],"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":[["","","Labetalol","100 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Rosuvastatin","40 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Finasteride","5 MG","","Select","Select",""],["","","Paroxetine Hcl","20 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Potassium Cl","10 MEQ","","Select","Select",""],["","","Furosemide","20 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":""}]}]}