{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Elizabeth M Sokolowski","gend":1,"currentgend":"","add":"43 GRAY RD","city":"NORTH YARMOUTH","state":"ME","zip":"04097","dob":"1951-08-14","age":"","mstatus":"","insh":"10000075393","cliId":"","pno":"8605756137","cno":"","email":"wilanow51@aol.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":"43 GRAY RD","madd2":"","madd3":"","mcity":"NORTH YARMOUTH","mstate":"ME","mzip":"04097","pcpfaxno":"2075351249","pcpnpi":"1114339611","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5G38JQ9EQ34","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M65331","Z1231","E782","E063","R079","R1011","R42","E785","K219","Z0000","R002","K743","R6889","I071","K5730","K648","K449","K2970"],"date":["2023-05-18","2023-05-22","2023-11-09","2023-12-27","2024-01-12","2023-06-01","2023-05-31","2023-12-27","2023-11-09","2023-11-08","2023-12-27","2023-12-29","2023-01-17","2024-01-12","2024-02-08","2024-02-08","2024-02-08","2024-02-08"],"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",""],["","","Fluocinolone 0.01 % Otic Oil Rising","","","Select","Select",""],["","","Fluocinolone 0.01 % Otic Oil Padagis","","","Select","Select",""],["","","Levothyroxine","50 MCG","","Select","Select",""],["","","Ursodiol","250 MG","","Select","Select",""],["","","Metronidazole 0.75 % Cream Fougera","","","Select","Select",""],["","","Meclizine","12.5 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Metronidazole 0.75 % Cream Viona Pharmaceu","","","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":""}]}]}