{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ann Lindsay","gend":1,"currentgend":"","add":"44 SHORELINE DR","city":"FALMOUTH","state":"ME","zip":"04105","dob":"1954-10-09","age":"","mstatus":"","insh":"10000070701","cliId":"","pno":"2077730051","cno":"","email":"yaslinan@gmail.com","ename":"","eno":"","pphy":"PANOZZO, SHASHI T","ppno":"2078469013","pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 8194","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04104","pcpfaxno":"2075238586","pcpnpi":"1255301701","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5RF7N35WH59","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D225","L84","L853","L570","D492","Z23","Z0000","E039","R790","Z0100","H6990","L821","Z1231","G454","Z8639","R413","R519","F419","H9042","J0110","Z0001","R5383","R42","Q6652","Q6651","M2022","M2021"],"date":["2023-05-01","2023-05-01","2023-05-01","2024-05-06","2024-05-06","2024-05-22","2024-04-19","2024-04-19","2023-05-19","2023-06-22","2023-08-31","2023-05-01","2023-10-23","2024-01-16","2023-12-22","2023-12-23","2024-01-16","2024-06-12","2024-05-06","2024-05-06","2024-05-22","2024-06-12","2024-06-12","2024-07-03","2024-07-03","2024-07-03","2024-07-03"],"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":[["","","Metronidazole 0.75 % Gel Cosette","","","Select","Select",""],["","","Levothyroxine","50 MCG","","Select","Select",""],["","","Escitalopram","5 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Acyclovir","800 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Buspirone","15 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Fluoxetine","20 MG","","Select","Select",""],["","","Lumigan","","","Select","Select",""],["","","Buspirone Hcl","","","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":""}]}]}