{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan E Healey","gend":1,"currentgend":"","add":"15 MAST LN","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1953-02-27","age":"","mstatus":"","insh":"10000061706","cliId":"","pno":"2076157978","cno":"","email":"shealey@maine.rr.com","ename":"","eno":"","pphy":"BUCHBERGER, GLENN K","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":"15 MAST LN","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":"2075238597","pcpnpi":"1598054702","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7AG1KA8GT98","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F329","F418","F5104","R7989","Z0101","Z85828","L820","L718","D1801","Z1231","Z23","J209","R6889","J4530","M25561","M7041","R600","Z0001","E785","E039","N83291","N83201","N83209","J4541"],"date":["2023-04-25","2023-04-25","2023-04-25","2023-04-14","2024-06-27","2023-06-28","2023-06-28","2023-06-28","2023-06-28","2023-07-13","2023-10-12","2023-10-18","2023-01-05","2024-02-21","2024-01-31","2024-01-31","2024-01-31","2024-02-23","2024-02-23","2024-02-23","2024-04-02","2024-04-02","2024-04-02","2024-05-21"],"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":[["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Levothyroxine","50 MCG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Sertraline","25 MG","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Metronidazole 0.75 % Cream Fougera","","","Select","Select",""],["","","Rosuvastatin","10 MG","","Select","Select",""],["","","Doxycycline Monohydrate","50 MG","","Select","Select",""],["","","Dexamethasone","4 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Famciclovir","500 MG","","Select","Select",""],["","","Clindamycin","300 MG","","Select","Select",""],["","","Advair Hfa","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Tranexamic Acid","650 MG","","Select","Select",""],["","","Metronidazole 0.75 % Cream Viona Pharmaceu","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Montelukast","10 MG","","Select","Select",""],["","","Celecoxib","200 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":""}]}]}