{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Hazel M Winchester","gend":1,"currentgend":"","add":"508 EAST RIVER RD","city":"PEMBROKE","state":"ME","zip":"04666","dob":"1956-07-01","age":"","mstatus":"","insh":"10000063526","cliId":"","pno":"2072147711","cno":"2072147711","email":"hazelphilips@yahoo.com","ename":"","eno":"","pphy":"RICHARDSON, WILLIAM B","ppno":"2078536001","pcpadd":"Eastport Health Care Inc, 30 Boynton St","pcpcity":"Eastport","pcpstate":"ME","pcpzip":"04631","pcpcounty":"","pcpid":"","pcpname":"EASTPORT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"508 EAST RIVER RD","madd2":"","madd3":"","mcity":"PEMBROKE","mstate":"ME","mzip":"04666","pcpfaxno":"3158292014","pcpnpi":"1457409617","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8F90Y06QT02","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H35363","H2513","Z1231","Z23","R600","S72012A","M533","S72002D","S72002A","R109","Z98890","S3991XA","S3993XA","I10","E785","S80862A","W57XXXA","Z471","Z96642","J449","E569","R1110","G8918","E559","Z0000","R7301","S7292XA","Z743","Z7401","R053","R2689"],"date":["2024-11-14","2024-11-14","2026-04-08","2025-09-12","2025-10-15","2025-10-15","2025-10-10","2025-12-03","2025-10-15","2025-05-13","2025-11-05","2025-10-17","2025-10-17","2025-11-24","2025-07-30","2024-10-28","2024-10-28","2025-12-12","2025-12-12","2024-12-12","2024-12-12","2025-05-05","2025-10-16","2024-08-26","2026-01-06","2025-08-04","2025-10-15","2025-10-15","2025-10-15","2025-05-13","2025-10-18"],"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":[["","","Tramadol","50 MG","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Gabapentin","100 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Rosuvastatin","20 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Enoxaparin Pf","40 MG","","Select","Select",""],["","","Lactulose","10 GM","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","Trelegy Ellipta","","","Select","Select",""],["","","Pravastatin","80 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Losartan","100 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Capvaxive","","","Select","Select",""],["","","Hydrochlorothiazide","25 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":""}]}]}