{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carole R Killeen","gend":1,"currentgend":"","add":"46 WOODLAND HILLS","city":"SOUTH BERWICK","state":"ME","zip":"03908","dob":"1944-01-23","age":"","mstatus":"","insh":"10000071605","cliId":"","pno":"2077520516","cno":"","email":"carole.killeen@icloud.com","ename":"","eno":"","pphy":"CHENAUSKY, MEGHAN C","ppno":"","pcpadd":"22 BRAMHALL ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41023134","pcpcounty":"","pcpid":"","pcpname":"YORK FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"46 WOODLAND HILLS","madd2":"","madd3":"","mcity":"SOUTH BERWICK","mstate":"ME","mzip":"03908","pcpfaxno":"2078102407","pcpnpi":"1619590247","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8K25YG4VW80","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E871","R252","D225","D2262","D2261","L814","H25813","M79642","M180","I4811","H25812","H5703","H25811","L218","L570","H02883","H02886","H01003","H01006","I872","H2512","I4891","M1990","M1812","L299","R350","R739","L820","R208","L538","L298","H5310","D329","R42","D320","F419","R918","R0989","I517","I700","R1011","R110","K5730","I708","R109","K2970"],"date":["2023-04-19","2023-11-20","2023-08-17","2023-08-17","2023-08-17","2023-08-17","2023-10-13","2023-09-12","2023-09-12","2023-09-26","2023-12-11","2023-10-13","2024-04-29","2023-10-17","2023-10-23","2023-11-14","2023-11-14","2023-11-14","2023-11-14","2023-12-04","2023-12-11","2023-12-11","2023-12-29","2024-02-06","2024-03-05","2024-06-17","2024-03-11","2024-04-18","2024-04-18","2024-04-18","2024-04-18","2024-04-29","2024-05-01","2024-04-24","2024-05-31","2024-06-25","2024-06-24","2024-06-24","2024-06-24","2024-06-24","2024-06-24","2024-06-24","2024-06-24","2024-06-24","2024-06-24","2024-06-24"],"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":[["","","Xarelto","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Perrigo","","","Select","Select",""],["","","Cefpodoxime","100 MG","","Select","Select",""],["","","Lorazepam","2 MG","","Select","Select",""],["","","Metoprolol Succ","25 MG","","Select","Select",""],["","","Mometasone 0.1 % Cream G&W","","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Sandoz","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","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":""}]}]}