{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Pamela J Hayes","gend":1,"currentgend":"","add":"61 BERWICK ST","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1954-02-23","age":"","mstatus":"","insh":"10000063904","cliId":"","pno":"2075360654","cno":"","email":"pamela.hayes55@yahoo.com","ename":"","eno":"","pphy":"ISACKE, ADRIANA C","ppno":"","pcpadd":"272 CONGRESS ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41013637","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"61 BERWICK ST","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":"2077744625","pcpnpi":"1316208762","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5RC7A45EJ56","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1159","Z1231","Z87891","Z6832","E782","I10","M79604","J439","J438","J449","J4530","Z129","N898","Z0000","E1129","E1151","H2513","E119","H4321","S29011A","N950","D251","N852","Z1289","Z1211","N858"],"date":["2024-04-30","2023-09-12","2024-03-06","2023-04-27","2024-06-04","2024-06-04","2023-05-17","2023-10-19","2023-07-11","2024-03-11","2024-03-11","2024-03-06","2023-09-22","2023-10-19","2023-10-19","2023-10-19","2024-01-05","2024-01-05","2024-01-05","2024-01-23","2024-04-30","2024-03-15","2024-03-15","2024-03-11","2024-04-05","2024-04-30"],"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":[["","","Albuterol Sulfate","","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Metformin","500 MG","","Select","Select",""],["","","Albuterol","1.25 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Abrysvo Act-O-Vial","","","Select","Select",""],["","","Breo Ellipta","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Meclizine","25 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Encube","","","Select","Select",""],["","","Lisinopril","40 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":""}]}]}