{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan J Emerson","gend":1,"currentgend":"","add":"104 PACKARD ROAD","city":"CORINNA","state":"ME","zip":"04928","dob":"1953-01-09","age":"","mstatus":"","insh":"10000058992","cliId":"","pno":"2072701263","cno":"2072701263","email":"acrylicsbysue@yahoo.com","ename":"","eno":"","pphy":"MACDONALD, MICHAEL C","ppno":"2073736848","pcpadd":"22 STATION AVE,SUITE 101","pcpcity":"BRUNSWICK","pcpstate":"ME","pcpzip":"40112092","pcpcounty":"","pcpid":"","pcpname":"HOMETOWN HEALTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"104 PACKARD ROAD","madd2":"","madd3":"","mcity":"CORINNA","mstate":"ME","mzip":"04928","pcpfaxno":"2073736849","pcpnpi":"1235220740","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1J43TP2NP74","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1231","I10","Z853","R922","Z780","M549","L821","L814","D225","Z7189","R739","R5383","Z0100","L820","L538","Z08","L570","R0609"],"date":["2024-05-20","2024-06-12","2024-05-30","2023-07-13","2024-05-30","2023-07-13","2024-04-11","2024-04-11","2024-04-11","2023-10-12","2023-10-10","2024-06-12","2024-01-09","2024-04-11","2024-04-11","2024-04-11","2024-04-11","2024-06-12"],"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":[["","","Spironolactone","25 MG","","Select","Select",""],["","","Pravastatin","20 MG","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Diphenox\/Atropine","2.5\/0.025 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Metoprolol Succ","100 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Hydralazine","10 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Celecoxib","200 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Fougera","","","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":""}]}]}