{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Doris C Page","gend":1,"currentgend":"","add":"16 HOYT ST","city":"SPRINGVALE","state":"ME","zip":"04083","dob":"1936-12-16","age":"","mstatus":"","insh":"10000074564","cliId":"","pno":"2074909800","cno":"","email":"dorispage10@yahoo.com","ename":"","eno":"","pphy":"BREAULT, TERESA M","ppno":"2076768559","pcpadd":"7 HIGH ST,","pcpcity":"NORTH BERWICK","pcpstate":"ME","pcpzip":"39066100","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"16 HOYT ST","madd2":"","madd3":"","mcity":"SPRINGVALE","mstate":"ME","mzip":"04083","pcpfaxno":"2076760982","pcpnpi":"1447211073","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1Y91KV4JN28","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25562","R221","J301","L309","R0781","S0003XA","W19XXXA","E041","S299XXA","E042","E7849","Z0000","L98491","M7712","L2084","Z23","M12811","M19011","M25511","Z0101","H5203","R2689","R252","R6889","J4520","M75101","M25512","N390","R0600","J101","Z87891","R531","J111","R5383","H6121","H8112","L820","I951","R300","R350","R3915","D649","I6523","L570","H903"],"date":["2023-05-19","2023-05-18","2023-05-18","2023-05-18","2023-05-26","2023-05-26","2023-05-26","2023-06-27","2023-05-26","2023-06-04","2023-06-09","2023-08-10","2023-08-10","2023-08-10","2023-08-10","2023-09-30","2024-01-12","2023-10-16","2024-06-05","2023-10-03","2023-10-03","2024-06-28","2023-11-03","2023-12-20","2023-12-13","2024-01-12","2024-06-05","2024-01-25","2024-01-25","2024-01-25","2024-01-25","2024-01-26","2024-02-06","2024-02-06","2024-02-19","2024-04-03","2024-04-03","2024-06-06","2024-05-09","2024-05-09","2024-05-09","2024-05-24","2024-06-06","2024-06-12","2024-06-28"],"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":[["","","Triamcinolone Acet 0.1 % Cream Taro","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Perrigo","","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Venlafaxine","37.5 MG","","Select","Select",""],["","","Meclizine","12.5 MG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Metoprolol Succ","100 MG","","Select","Select",""],["","","Losartan","50 MG","","Select","Select",""],["","","Triamterene\/Hydrochlorothiazide","37.5\/25 MG","","Select","Select",""],["","","Meloxicam","7.5 MG","","Select","Select",""],["","","Amlodipine","2.5 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":""}]}]}