{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia L Harford","gend":1,"currentgend":"","add":"44 BROOKS EDGE FARM RD","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1953-05-15","age":"","mstatus":"","insh":"10000064965","cliId":"","pno":"2077496344","cno":"2077496344","email":"Palharford@yahoo.com","ename":"","eno":"","pphy":"EDWARDS, CHRISTINA S","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":"44 BROOKS EDGE FARM RD","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":"2075238597","pcpnpi":"1326334335","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6KW5MG2WH82","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":["H8112","R42","M818","Z0000","R7303","E7800","R6889","J383","M810","Z1231","M8588","J3802","R061","R490","R1310","R0603","J3800","N3281","J387","J386","N390","R3915","G959","R3121","K219","J300"],"date":["2023-05-22","2023-05-22","2023-05-22","2024-03-05","2024-06-04","2024-06-04","2023-01-01","2023-12-07","2024-06-04","2023-07-19","2023-07-19","2024-05-21","2023-07-25","2023-11-21","2023-08-02","2023-08-02","2023-08-25","2024-04-03","2023-09-29","2023-11-21","2024-01-24","2024-04-03","2024-02-14","2024-06-04","2024-06-04","2024-02-20"],"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":[["","","Fluzone High-Dose","","","Select","Select",""],["","","Rosuvastatin","10 MG","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Epinephrine","0.3 MG","","Select","Select",""],["","","Esomeprazole Mag","20 MG","","Select","Select",""],["","","Buspirone","10 MG","","Select","Select",""],["","","Flovent Diskus","","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Esomeprazole Magnesium","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Ipratropium 0.06 % Nas Spray Advagen","","","Select","Select",""],["","","Ipratropium 0.06 % Nas Spray Amneal","","","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":""}]}]}