{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sara A Dyer","gend":1,"currentgend":"","add":"20 UNDERPASS RD","city":"NEW GLOUCESTER","state":"ME","zip":"04260","dob":"1939-07-12","age":"","mstatus":"","insh":"10000069348","cliId":"","pno":"2075209370","cno":"","email":"sdpepper@securespeed.us","ename":"","eno":"","pphy":"HILARY, MANJU","ppno":"2076573308","pcpadd":"126 SHAKER RD,","pcpcity":"GRAY","pcpstate":"ME","pcpzip":"40399629","pcpcounty":"","pcpid":"","pcpname":"GRAY FAMILY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 239","madd2":"","madd3":"","mcity":"NEW GLOUCESTER","mstate":"ME","mzip":"04260","pcpfaxno":"2076573309","pcpnpi":"1710066410","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6XR7QN0YJ59","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z932","H6123","R0602","G629","R300","M6530","M5440","M65341","R600","I509","I2720","I4891","R7989","I4892","E871","R632","E161","Z0000","K219","J45909","H401121","H401231","G43909","R519","R062","M5432","N649","R059","N6321","J181","L299","I4820","R1010","Z7689","H401131","Z87891","J4521","J208","N6324","I700","T7800XA","I10","N1831","J4541","H40013"],"date":["2026-03-03","2023-05-18","2025-11-13","2023-05-15","2023-05-15","2023-05-18","2023-07-13","2023-05-30","2023-07-25","2023-06-28","2025-11-13","2025-11-13","2023-08-01","2023-07-25","2023-10-13","2023-10-13","2023-10-13","2025-11-03","2024-06-19","2024-06-19","2024-03-04","2025-01-02","2024-06-19","2024-12-27","2025-02-17","2025-07-10","2025-12-18","2025-02-17","2026-01-07","2025-02-17","2024-12-27","2025-06-19","2025-08-06","2025-03-13","2025-07-08","2024-12-27","2024-08-05","2024-08-05","2026-01-07","2025-12-09","2024-12-27","2025-09-01","2025-11-13","2024-08-26","2023-02-14"],"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":[["","","RIZATRIPTAN","10 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","LEVOTHYROXINE","50 MCG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","FREESTYLE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FREESTYLE LITE","","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Somerset","","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","ACARBOSE","25 MG","","Select","Select",""],["","","FREESTYLE FREEDOM LITE","","","Select","Select",""],["","","Potassium Cl","750 MG","","Select","Select",""],["","","PFIZER-BIONTECH GRAY","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","FLUBLOK","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Sandoz","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","LATANOPROST","0.00005","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","POTASSIUM CL (","750 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":""}]}]}