{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy K Moriba","gend":1,"currentgend":"","add":"21A CLEAVES ST","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1962-07-21","age":"","mstatus":"","insh":"10000059566","cliId":"","pno":"2079396570","cno":"","email":"nmoriba8114@gmail.com","ename":"","eno":"","pphy":"PIERCE, DANIEL C","ppno":"2078469013","pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"21A CLEAVES ST","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":"2078741483","pcpnpi":"1861451080","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1DG1D49JN94","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79899","Z0101","M25511","M75101","M19011","E1159","E785","E039","R6889","R400","R142","Z0001","G4733","Z23","E349","R110","R0683","G4719","I10","M75121","M7551","K2960","R4182","K2270","E8352","M75111","K219","R112","E119","R519","R5383","M8588","E668","K8020","G44209","F439","R251","K130"],"date":["2024-06-03","2024-05-30","2024-03-13","2024-01-22","2024-03-13","2023-11-14","2024-03-04","2023-11-13","2023-05-07","2023-09-11","2024-02-22","2023-11-30","2024-05-06","2023-12-08","2023-12-08","2024-05-20","2023-11-08","2024-04-23","2024-06-17","2024-02-12","2024-03-13","2024-05-20","2024-03-04","2024-05-20","2024-06-03","2024-03-27","2024-03-04","2024-02-22","2024-03-04","2024-02-22","2024-02-22","2024-04-09","2024-04-23","2024-05-20","2024-06-12","2024-06-12","2024-06-12","2024-06-17"],"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":[["","","Dextroamphet\/Amphet","20 MG","","Select","Select",""],["","","Sucralfate","1 GM","","Select","Select",""],["","","Methylphenidate","10 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Dent Paste Taro","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Lithium Carb","300 MG","","Select","Select",""],["","","Metformin Hcl Er","","","Select","Select",""],["","","Mounjaro","","","Select","Select",""],["","","Quetiapine","25 MG","","Select","Select",""],["","","Lurasidone","20 MG","","Select","Select",""],["","","Lurasidone Hcl","","","Select","Select",""],["","","Rosuvastatin","40 MG","","Select","Select",""],["","","Butal\/Acetaminophen\/Caffeine (Exempt) 50\/3","","","Select","Select",""],["","","Caplyta","","","Select","Select",""],["","","Hydralazine","10 MG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","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":""}]}]}