{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Camilla A Adams","gend":1,"currentgend":"","add":"112 BAKER RD","city":"FREEPORT","state":"ME","zip":"04032","dob":"1954-11-24","age":"","mstatus":"","insh":"10000071054","cliId":"","pno":"2078653510","cno":"","email":"ladycamilla@hotmail.com","ename":"","eno":"","pphy":"NEWCOMBE, JODI A","ppno":"2075351200","pcpadd":"385 ROUTE 1,","pcpcity":"YARMOUTH","pcpstate":"ME","pcpzip":"40966729","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE YARMOUTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"112 BAKER RD","madd2":"","madd3":"","mcity":"FREEPORT","mstate":"ME","mzip":"04032","pcpfaxno":"2075351249","pcpnpi":"1114339611","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6WK5CD1FH92","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","J45998","J4530","G4733","R059","Z1231","E1159","E079","Z136","Z0000","R079","R0602","J849","M79643","H26493","H26491","L918","J45909","I9589","M19032","M25532","M79645","M19041","I2510","J9811","R0600","R55","E782","L821","L299","R0902","E785","E119","I10","E063","E1165","J0180","E668","E875","R718","R7309","E039","E038","Z1152","D123","D125","K644","K219","D509","K635"],"date":["2024-06-11","2023-08-30","2024-03-01","2024-05-22","2024-02-24","2024-07-05","2023-08-15","2023-07-13","2023-07-13","2023-07-18","2023-10-17","2023-07-27","2023-07-27","2023-07-18","2023-07-12","2023-07-12","2023-08-15","2024-02-24","2023-07-25","2023-07-27","2023-07-27","2023-07-27","2023-07-28","2023-08-02","2023-07-27","2023-08-02","2023-08-23","2023-10-18","2023-08-15","2023-08-15","2023-08-23","2023-08-23","2023-10-13","2023-10-18","2024-01-17","2023-10-18","2024-03-01","2024-03-01","2024-03-08","2024-04-02","2024-04-02","2024-04-02","2024-04-02","2024-02-24","2024-04-25","2024-04-25","2024-04-25","2024-04-25","2024-04-25","2024-04-25"],"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":[["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Levothyroxine","150 MCG","","Select","Select",""],["","","Abrysvo W\/ Diluent Syringe","","","Select","Select",""],["","","Betamethasone Val 0.1 % Ointment Fougera","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Advair Hfa","","","Select","Select",""],["","","Breo Ellipta","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Metformin","500 MG","","Select","Select",""],["","","Wixela Inhub","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Citalopram","20 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":""}]}]}