{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Louisa G Anderson","gend":1,"currentgend":"","add":"11 CAPE RD","city":"Hollis Center","state":"ME","zip":"04042","dob":"1950-12-28","age":"","mstatus":"","insh":"10000074462","cliId":"","pno":"2079298387","cno":"","email":"lg.anderson202@gmail.com","ename":"","eno":"","pphy":"SULLIVAN, RACHEL","ppno":"","pcpadd":"\tMartins Point Health Care,\t575 Main St","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 CAPE RD","madd2":"","madd3":"","mcity":"Hollis Center","mstate":"ME","mzip":"04042","pcpfaxno":"2075242093","pcpnpi":"1851954218","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3KA6K64PW46","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":["I70203","L602","I4891","Z7901","L570","D492","L720","L603","C44319","L820","M0579","Z79899","R262","Z0101","Z1231","Z23","D485","L821","H401230","H401213","I4820","H40013","I4821","I10","E7800","M8589","E785","S50862A","S20161A","W57XXXA","L539","H401233","K5792","R109","M5450","K5732","K8020","K7689","R1032"],"date":["2024-05-13","2024-05-13","2024-05-14","2024-05-30","2024-02-27","2024-02-27","2023-08-01","2023-08-01","2023-05-15","2024-02-27","2024-05-20","2024-05-20","2024-03-06","2024-07-01","2024-07-15","2023-07-10","2023-08-01","2024-02-27","2023-08-29","2023-09-26","2024-01-17","2023-08-10","2023-10-26","2024-01-17","2023-10-26","2024-05-20","2024-01-17","2024-04-22","2024-04-22","2024-04-22","2024-04-22","2024-04-18","2024-05-03","2024-05-03","2024-05-03","2024-05-03","2024-05-03","2024-05-03","2024-05-03"],"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":[["","","Jantoven","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Methotrexate","2.5 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Estradiol 0.01 % Vag Cream Padagis","","","Select","Select",""],["","","Leucovorin","5 MG","","Select","Select",""],["","","Valacyclovir","1 GM","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Lovastatin","10 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Timolol Mal (Twice Daily) 0.5 % Ophth Sol","","","Select","Select",""],["","","Leucovorin Calcium","","","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":""}]}]}